185 - Educational Resources for Health Care Providers

185 – Educational Resources for Health Care Providers

Dr. Sandie Morgan and Dave Stachowiak revisit the important influence of health care providers on human trafficking victims. They discuss new resources that have moved away from awareness, and into a more training focused aspect in order to identify and assist a trafficking victim. They discuss the significance of health care providers creating a four-step plan to assist victims through a safety plan, knowing how to refer, understanding mandatory reporting, and establishing a protocol.

Key Points

S.O.A.R. (stop, observe, ask, and respond to human trafficking) has provided new resources for health care providers, see below.
The first part of a plan to assist victims is safety. A safety plan can include having resources available to give victims.
Along with this, is knowing how to refer victims to the proper resources.
The next step for health professionals is understanding the mandatory reporting requirements and steps to take for a victim-centered approach.
Protocols are complicated and require a lot of processes, quality assurance, and a legal team. However, once that is in place, frontline health care providers will be empowered to actually identify and assist human trafficking victims.

Resources

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Transcript

Dave: [00:00:01] You’re listening to the Ending Human Trafficking podcast. This is episode number 185, Educational Resources for Health Care Providers.

Production Credits: [00:00:10] Produced by Innovate Learning, maximizing human potential.

Dave: [00:00:30] Welcome to the Ending Human Trafficking podcast. My name is Dave Stachowiak.

Sandie: [00:00:35] And my name is Sandie Morgan.

Dave: [00:00:38] And this is the show where we empower you to study the issues, be a voice, and make a difference in ending human trafficking. Sandie as we were preparing for today’s conversation on educational resources for health care providers, we were discussing some of the past episodes that we’ve aired. Actually, a bunch of episodes specifically diving in with health care providers and some of the resources available and this prompted me wondering well what is new? What’s the reason for us revisiting this topic? And It turns out there’s a whole bunch of things that are new, aren’t there?

Sandie: [00:01:16] Absolutely. I think there is a growing sense that our health care providers are seeing victims of human trafficking, both sex trafficking, and labor trafficking, and they need more tools to help them identify to assess and to take some sort of action. And I think one of the early episodes that we did on this was with Laura Letter. Her research has become seminal in pushing this agenda forward. One of the initiatives that are out there, and I’m going to pull it up really quick, is the infographic that S.O.A.R. did. S.O.A.R. is stop, observe, ask, and respond to human trafficking. And so, when people are approached in a health care environment, administrators, directors, nurses, doctors the first thing they want to understand is why do we need to do this. And the infographic that S.O.A.R. put together actually identifies two basic premises. One is that the number of endangered runaway youth that are likely to be sex trafficking victims is one in six of those runaways. And that’s a powerful number when you realize that one person that is able to stop for a moment observe what’s going on. What are the verbal and nonverbal indicators? Ask a question. I don’t know how many times a survivor has said to me if someone would have asked, but nobody asked. And then finally the end of that acronym stop, observe, ask, and respond and the response is possibly going to be different depending on the circumstances. So that one in six graphics is super important, but the other. And we interviewed Laura Letter in podcast Number 106 about her research and they use this statistic here 87.8%. The amount of human trafficking victims that have come in contact with health care professionals that didn’t realize who they were seeing. So, this is justification for really ramping up our focus on equipping health care providers.

Dave: [00:03:42] This is one of those areas Sandie that I know as we’ve talked through it over a number of years on the show I think I appreciate this more than I did. But at first, I came to this conversation I think where some of our listeners will come to, especially if you’re picking up the episode or one of the first episodes are listening to of thinking like well what’s the need to educate health care providers on human trafficking more so than any other profession? Of course, we all need education on it, but what you just said is so critical in that often the health care provider is the person that comes into contact.

Sandie: [00:04:20] Actual, physical contact.

Dave: [00:04:23] Not only with the victim but also potentially with the trafficker, potentially in the same room.

Sandie: [00:04:28] That’s why training is so important because you don’t want to take risks that might put your patient at risk. And I think for listeners that you’re not a health care provider, you know a health care provider that hasn’t jumped into this conversation yet. And Dave you may be sitting in your studio, you may be out training leaders, and doing all kinds of wonderful things where you don’t engage with trafficking victims, but you might see something when you’re driving by a sight. But you do know people who are physicians, and nurses, and radiology technicians, and so on and so forth. And I think we limit our ideas about who health care providers are. Health care providers are school nurses, and they are walk-in clinic workers, and sometimes they’re the receptionist in that walk-in clinic, and they’re the person who sees them for the very first time. Primary care physicians often think that this is not happening in their offices and yet we have story after story where a victim actually went to a doctor’s office, used their medical cards, and was able to receive services, and no one even asked that question. So, the stop, observe, ask, and respond acronym is a good model.

Sandie: [00:05:57] I want to look at a new resource. We were introduced to Katherine Chon at the Office on Trafficking in Persons and Health and Human Services. And I think for our listeners, we need to understand the difference between resources. Last episode we received resources for the faith community toolkit from our Homeland Security. Now Homeland Security it’s all about law enforcement, criminal justice, all of those things. But the other side of the equation is Victim Services. And Health and Human Services have a more victim-centered approach to how they do training. And so, they’ve been since they started the O.T.I.P. Office, Office on Trafficking in Persons, been very intentional about providing additional resources and developing great resources for the different sectors social workers as well as health care providers. And this last summer, they released a new flyer. It’s more of a brochure that carefully provides a look at what a health care provider needs to understand.

Dave: [00:07:11] In the last few years Sandie, I know so much has emerged not only on awareness of this as you and I have discussed but also on resources that are available now as the recognition of this has become even more substantial. What is new in the last couple of years that we should be considering and thinking about either as health care providers ourselves for those for those in our community or for like you were saying those of us that know health care providers or part of the broader community?

Sandie: [00:07:42] Well I think one of the big things is we’ve moved away from awareness and now we actually are training health care providers to identify and assist a trafficking victim. And knowing how to do that means that we’re taking this to a more professional approach and making recommendations for how directors administrators can develop protocols that are then useful for the everyday health care provider nurse, doctor, clinical assistant, whatever to be able to take action when they see something.

Dave: [00:08:21] When you say moving away from awareness, is it that moving away from just focusing on like there is a problem out there to now getting much more concrete or is there some other distinction there?

Sandie: [00:08:31] I think it’s moving into having concrete steps. So, if you go back, I didn’t go back and listen to our podcast. I think the first podcast that we did was podcast number 36 and we just established that health care providers are important and the reason why. And we’ve offered resources that included the 888-3737-888 hotline number and posters that you can put up and so the idea was more along the lines if you see this make this call. Well, now we’ve moved into an area of expertise where we actually have a plan to assist victims. It’s a four-step plan. The first one and this is becoming more and more you’re going to hear me say this all the time. A safety plan, we start with safety. And many of our listeners who have already got a background in domestic violence, safety has always been the first step in assisting someone leaves an abusive relationship. And so, helping your patient develop a safe exit strategy, a safe exit strategy may not be a rescue in the emergency room with the trafficker right there and only that victim is going to be able to provide the information you need to know what steps to take next. Sometimes, unfortunately, we’ve watched so much Hollywood movies that we have a rescue mentality and so we have this sense, OK this is a trafficking victim I can tell because he’s a construction site injury but he’s not wearing any of the safety equipment clothing that he’s required to wear. So that means he’s not working in a legal environment. And so, this is at least labor exploitation and possibly trafficking. So how can I help him? And he’s with someone who’s translating for him, someone who is making all of the decisions, and has his documents, all of these are little signs, but it is not something where you can do the rescue right this minute. So, the second step in our assist program is to refer. And you need to know how to refer and who to refer. And every institution needs to be able to sit down with a strategic planning committee and create the algorithms for if this happens, this is what we do next. And the referral part would be included in your local approach to this, a directory of resources that are trafficking proficient. And for instance, right here in Orange County. That’s easy to do because we have a very stable and established Orange County Human Trafficking Task Force. You may live in an area of the country where there’s very little already established, but there are national offices at the Office on Trafficking in Persons that can help you identify local victim services that you can refer to.

Dave: [00:11:54] For those organizations that may be taking the first step on this Sandie, and don’t have that resource that’s obvious and apparent like we have here in Orange County, is the National Human Trafficking Hotline a starting point? Or are there other places that would be a good first step in figuring out what should be on the referral list?

Sandie: [00:12:14] The National Human Trafficking Hotline is supported by the Office on Trafficking in Persons from HHS. So, it’s very connected and it’s 24/7. So, if you’re a night nurse you can call that number and get help. And it has a referral directory. It has ways of connecting directly to a victim. And part of your safety plan or your referral may be just to give the patient a card that has the referral number and the text number. Many times, especially with younger victims, they don’t want to make a phone call. They want to text everybody texts and so you can text to be free, 23-3733 to get help immediately for yourself. So, you have a little more control about when and how that happens. I think that setting up those local relationships has been a bit of a challenge in more remote parts of the country. And so, when I talked to health care providers that come from maybe rural areas they often say to me well we don’t have human trafficking here. And then I pull up some of the biggest federal cases and there are huge labor trafficking cases out in rural areas harvesting tomatoes, harvesting strawberries. A trafficking case where people with disabilities were trafficked and didn’t know how to ask for help. So, it is important across every sector, geographical and socio-economical, that the health care providers who are the ones who will see people, actually have this information and know how to assist. And part of that assist process includes understanding mandatory reporting, depending on what kind of case it is. Obviously, if it’s a child, someone under the age of 18, who have been commercially sexually exploited. You’re a mandatory reporter already under child sexual abuse laws. So, there’s no gray area on those things. But sometimes, especially in the area of labor trafficking, it’s harder to know how to report and that’s when referring for services is your next option. And that’s not going to be clear and doable for the health care provider unless we take step number four in the assist plan which is developing a protocol. And protocols people, I’m a nurse remember protocols are complicated and require a lot of processes, quality assurance, your legal team. But once you have that in place your frontline health care providers will be empowered to actually identify and assist human trafficking victims.

Dave: [00:15:21] You have also personally done a lot of new things Sandie on this. And I know speaking of partnerships, as we talk about often, one of the partnerships you have is within Vanguard University, the nursing program. And many times, over the years of work collaboratively with the faculty they urged students to raise awareness on this. As you’ve had those conversations, what are the things that you’re finding that are either helpful on a protocol standpoint or bigger things that health care providers should be thinking about when implementing this system?

Sandie: [00:15:51] I actually have been doing a guest lecture for five or six years in the community health class every semester. And just this month they said you know we better just do a video of this in case you’re not going to be around because you’re too busy or whatever. And so, they made a video, they are giving that video to us, we’re going to put a link in our show notes. And for those who are really dedicated, it is not a 30-minute podcast it’s an hour and 45-minute training for nurses specifically for nurses. But it goes into legal definitions so that you can understand your mandatory reporting requirements. It also goes into the practices that traffickers use to recruit and to coerce and trap their victims. And also focuses a great deal on a trauma-informed approach and the steps to take to make sure that you are using a victim-centered approach. And so, it’s a valuable resource for those on the ground who need to have training right now. They’re also going to be online training resources available through the O.T.I.P. office that will offer CEUs and CMEs for health care providers at Ensure Justice. Every year we have a workshop track for health care providers and at this point, we’ve been able to offer CEUs for nurses and we’re adding for March 1st and 2nd in 2019, CMEs for medical professionals. And so, we’re ramping up providing professional training materials so that our healthcare providers have access to equip their leaders. And what I have learned is and I’ve trained, my assistant went through a couple months ago and just tallied up since we started actually tracking two and a half years ago how many healthcare providers I have done training for in classrooms, in an emergency room department, at a hospital training, at a school nurse conference, over 4000 individuals. That’s me standing in front of a class of 30 or 40 people that’s a lot of presentations. It’s not sustainable. It’s not replicable. So, we want to move to a more focused and replicable model and that means we’re going to add to our online resources in the Anti-Human Trafficking Certificate, a course for health care providers. We already have an aftercare course, but we want to have a course specifically for health care providers. We’ll put the link to the Office on Trafficking in Persons course resources on our Web page as well. It is so important for the whole team, the whole health care. We talk in health care about team leadership, but we have to equip the entire team to identify and assist victims of human trafficking so that we can make it a more productive approach to referring and creating safety plans.

Dave: [00:19:28] It’s also a good reminder for those who are really looking to do more on studying these issues is the Human Trafficking Certificate Program. And if you’d like to find out a little more, the endinghumantrafficking.org website is a good starting point for that and will take you into some more information. Sandie, it’s so exciting to hear that the curriculum is continuing to expand and that health care focus is going to be one of those areas. Like you said, it’s as much as you and I have both done this a lot in our careers of getting in front of audiences and do training or do facilitation. And there’s a time and a place for doing that. And in addition, if we can have some of these resources online that are easier to scale and to utilize regardless of geography and time that really does help us all to learn in a more effective and more efficient way. It’s exciting to see that coming together.

Sandie: [00:20:16] Well we get a lot of communication and I get a lot of emails. And as we have developed our endinghumantraffickin.org website, one of the things we’re going to be doing in the next few months is launching a monthly newsletter and that will give you more opportunity to engage with us. One of the things that we want to do is hear from you, hear what you want to hear on these podcasts and be more responsive. I think one of the things in the area, especially for health care providers, is understanding what kind of resources and how you would like to have those delivered. That’s a critical piece. One of the things that I do know about healthcare provider training is inviting you to come to us at Vanguard University. It works for a few people but not for the majority which is why I’ve been so willing to go. I’m going again here in November to Colorado to speak to the National Nurses in AIDS work because they are from across the nation and everything we teach them they’ll take back to those geographical regions. So, we’re not going to quit doing the I’m going to stand in front of you, but we do want to multiply our effectiveness and find ways to deliver resources to healthcare providers that are doable.

Dave: [00:21:47] One of the things that happens a lot is people do reach out to us Sandie and you specifically and at the center asking for that first step. And as many resources as there are available, sometimes there’s so many it’s hard to know where to start. And if you are in a health care organization, or you’re a provider, or maybe you’re in a place that has not really considered this much yet. For those who are looking for that first step or someone that can come alongside them and be a guide, what would you recommend as a first step in that process?

Sandie: [00:22:19] Well, of course, I want you to subscribe to this podcast because we’re always adding content, trauma-informed care, and those kinds of things. We bring survivor voices for you. You can listen to someone who actually went through this. And that survivor voice really informs a lot of how we respond when we see trafficking victims. But this new resource from the Office on Trafficking in Persons is available. We’ll have the link in English and in Spanish. And they also have a little business-sized card that you can distribute. They have posters that you can put up. That’s a great starting place it’s a brand-new resource. It’s very succinct. You can do a change of shift briefing and just walk through the steps to identify and assess the list of indicators. And then, of course, the assist plan of creating a safety plan, knowing how to refer, understanding mandatory reporting, and establishing a protocol that’s where you can start.

Dave: [00:23:33] Perfect. And Sandie one of the other things that I think might make sense here is to also mention some of the other episodes that we have aired previously because there is so much that we as you mentioned not only subscribing to the show but maybe going back specifically to the archives if you are a health care provider that will be of real value to you. One of them is episode number 36, Why Health Care Providers Matter and What Do They Do, that answered the question that I asked when we first started this journey together Sandie. Like well, why health care providers? What’s special about providers that are different than other professions? And of course, there are so many things that are specific to health care providers so episode 36 is a great starting point for that. Also, episode 59 was an interview with One Love for Nurses. Episode 106, Health Consequences of Human Trafficking, you mentioned the work of Dr. Laura Lederer Sandie earlier and she was our guest on that episode talking through the details of that research. And then also episode 159, What is a Medical Home, our interview with Dr. Ron chambers. And so, a lot of ground we’ve covered already. So, for those who are looking for more, we certainly recommend those episodes. Sandie, in addition to that we’re going to put all the links to the resources that you have identified for us in the notes of course. Anything else that health care providers should be thinking about as a first step?

Sandie: [00:24:54] Well I think expanding their own knowledge and following up, listening to those podcasts, following the links. But when a health care professional has a question you don’t have to give your name, you don’t have to do anything formal to report a case, call the 888-3737-888. Because I often talk to people who work the night shift and maybe they feel like they’re going to see more of this because of the time of day that they’re there. The National Human Trafficking Hotline is also a resource center where somebody can talk you through some of your questions and refer you to someone else. You can also send questions to us at feedback@ending humantrafficking.org And we’ll do our best to connect you to resources in your area and to online resources.

Dave: [00:25:54] Sandie, as always, we’ve got a lot here. So, we’re going to put all the links in this episode notes. Just go to endinghumantrafficking.org And this is episode number 185. And in addition, we would invite you to take a moment, if you have not already, to download Sandie’s guide on the Five Things You Must Know, A Quick Start Guide to Ending Human Trafficking. That is going to provide you with two immediate resources that will get you started in this journey of ending the trafficking. The first thing is that guide itself is going to provide a number of starting points for you especially if you’re joining us for one of the first times listening to this episode. It’ll give you the place to start, as far as the key things that will help you to support us in our efforts. Secondly, is it will also register you for the newsletter upcoming that Sandie mentioned that we will begin providing. That’s another excellent resource for continuing education and resources not only from Sandie but from the entire Global Center for Women and Justice. You can get access to that just by going to endinghumantrafficking.org right on the front page where you’ll see Sandie’s smiling face and you’ll also see the link to download that e-book and you can register right there. Sandie, we’ll be back in two weeks for our next conversation. Thanks again, as always.

Sandie: [00:27:23] Thank you, Dave.

Dave: [00:27:24] Take care, everyone.