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Identifying Victims of Human Trafficking Eric Roath, Pharm.D. Director of Professional Practice Michigan Pharmacists Association
Learning Objectives 1.
Describe the types of human trafficking, and the larger societal problems associated with human trafficking.
2.
Recognize the warning signs of trafficking and how to identify trafficking victims in pharmacy and health care settings.
3.
Provide resources for pharmacy personnel to report identify and support suspected victims of human trafficking.
Why are we having this conversation?
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New Requirement in MI Law 333.16148 – (1) …By 2 years after the effective date of the amendatory act that added this sentence, the department shall promulgate rules to include training standards for identifying victims of human trafficking required for individuals licensed or registered under this article, except those licensed under part 188 or subject to section 17060. The training standards for identifying victims of human trafficking shall apply for a license or registration renewal beginning with the first renewal cycle after the rules are promulgated and for an initial license or registration issued 5 or more years after the rules are promulgated.
Training Must Cover… • Understanding
the types and venues of human trafficking in the United States
• Identifying
victims of human trafficking in health care settings
• Identifying
the warning signs of human trafficking in health care settings for adults and minors
• Resources
for reporting the suspected victims of human traficking
Acceptable providers or methods of training: •
Training offered by a nationally-recognized or staterecognized health-related organization.
•
Training offered by, or in conjunction with, a state or federal agency.
•
•
Training obtained in an educational program that has been approved by the board for initial licensure or by a college or university. Reading an article related to the identification of victims of human trafficking that meets the requirements of the law and is published in a peer review journal, health care journal, or professional or scientific journal.
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To prove you have completed training: • An
individual must be able to produce:
Proof of completion certificate issued by the training provider A self-certification statement by an individual containing: The date, training provider name, and name of training The title and author of an article, publication name where the article was published
https://www.youtube.com/watch?v=dqCSgCDGNT8
“25 Facts About Human Trafficking”
Types of Human Trafficking
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Sex Trafficking • Most
commonly thought of form of human trafficking
• Recruitment
and transportation of persons for sexual exploitation
Force Labor • Victims
are coerced or forced to work for free or less than standard wages.
• Immigrants
are particularly susceptible
Confiscated identification documents Threat of deportation • Although
more common for immigrants, it can affect any individual regardless of citizenship status or ethnicity.
Child Labor • Minors
under the age of 18 are coerced into work through either physical or psychological force.
• Consent
is not a mitigating factor (minors cannot consent to exploitation).
• Indications
of exploited labor:
Harsh working conditions Substandard or no wages Inability to attend school
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Debt bondage • Trafficking
victims are forced into labor as repayment of real or alleged debt
• Time
spent does not necessarily apply towards the debt, or the debt amount is unspecified
• The
alleged “debt” can be increased as punishment for poor behavior
• Unreasonable
high interest on loans can also result in forms of debt bondage
Involuntary Servitude • Subset
of forced labor that involves workers who live and work in the same setting
• Usually
occurs in the bosses home or on some other form of private property
• Victims
may receive little or no pay
• May
be kept in the position through psychological means
Child Soldiers •
Boys and girls under 18 years of age recruited to serve in armed forces
•
Includes roles other than combat roles: Cooking Labor Espionage Messengers Sexual Exploitation
•
Since 2011, 19 countries have been reported to use child soldiers in their national army or in armed opposition groups
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Human Trafficking in Michigan • 13th
out of the 50 states for highest number of trafficking victims
• International
border with Canada attributed with relatively high human trafficking rate
• Detroit
identified as a major entry point for human trafficking victims
• Poverty
levels and number of foreign-born workers also considered a factor
Identifying Victims of Human Trafficking
General Warning Signs • Injuries
or signs of physical abuse
• Malnourished • Disorientation • Lack • Few
of identification documents
personal belongings
• Nervous • Unable
or hesitant to talk to strangers
to recall his or her own address
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General Warning Signs (Continued) • Minors
in relationships with much older persons
• Avoids
eye contact
• Lack
of change or appropriateness of wardrobe
• Fear/distrust • Rarely
of law enforcement
permitted to be in a location alone
• Generally
fearful, anxious or submissive
• Attests
to long work hours, inability to leave work, or harsh working conditions
Child-Specific Warning Signs • No
access to parents/guardians
• Lack
of socialization
• Truancy
from school/Lack of education
• Intimidated
affect (atypical for their age)
• Association
with unrelated individuals
• Frequently
unaccompanied by adults
• Reports
home
of strange or inappropriate treatment at
Healthcare “Red Flags” •
Always escorted to and from appointments
•
Escort speaks for the patient
•
Inconsistencies in stories provided by the victim
•
Victim may be unsure how they were injured
•
Multiple STIs; Unclear on how they contracted a disease
•
Request certification that they are no longer infected with an STI
•
Advanced symptoms due to lack of care or untreated injuries
•
Branding, scarring, or tattoo that may indicate ownership
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Healthcare “Red Flags” •
No insurance coverage/cash payments
•
Pregnancy tests or multiple pregnancy concerns
•
Prescriptions are routinely lost or stolen
•
Frequent injuries
•
Pain level remains unchanged, despite pain medications patient is taking
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Frequent filling of medications for STIs
•
Oral contraception in young women
•
STIs or pregnancy tests for inappropriately young women
Areas worth screening: •
Are victims being forced into behavior they don’t want?
•
Are victims able to change situations they express discontentment with?
•
Have victims been physically harmed?
•
What are the victims living and working conditions like?
•
Do the victims have appropriate documentation/identification when obtaining prescriptions?
Resources for Reporting Suspected Trafficking
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National Human Trafficking Resource Center • http://www.traffickingresourcecenter.org • National
anti-trafficking hotline and resource center serving victims and survivors of human trafficking
• Mission
is “to provide human trafficking victims and survivors with access to critical support and services to get help and stay safe and to equip the anti-trafficking community with the tools to effective combat human trafficking.”
US Department of Justice Worker Exploitation Complaint Line • For
reporting suspected instances of trafficking
• 1.888.428.7581 • Any
details you can provide will aid in the investigation
U.S. Immigration and Customs Enforcement’s Victim Assistance Program • http://www.ice.gov/ • Specifically
workers
for suspected cases involving migrant
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Resources & Phone Numbers • • •
•
National Human Trafficking Resource Center 1.888.373.7888 Law enforcement for Human Trafficking 1.866.347.2423 (911 for emergencies) U.S. Department of Justice Worker Exploitation Complaint Line 1.888.428.7581 US Immigration and Customs Enforcement’s Victim Assistance Program 1.866.872.4973
Acknowledgements This presentation was developed, in part, using information and resources compiled in the home-study program, “Identifying Victims of Human Trafficking” by Amy Montague. Copyright, Michigan Pharmacists Association, 2015. Home study and other resources can be made available upon request for training of additional healthcare personnel. Please contact Mary Farrington at (517) 484-1466 or by e-mail at
[email protected]
References •
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United Nations Office on Drugs and Crime. Human Trafficking. 2015. http://www.unodc.org/unodc/en/human-trafficking/what-is-humantrafficking.html#What_is_Human_Trafficking. July 30, 2015. The Human Trafficking Training Institute. Human Trafficking Awareness Training 101 for Healthcare Professionals. Oct. 18, 2014. http://www.jhsph.edu/research/centers-and-institutes/johns-hopkinseducation-and-research-center-for-occupational-safety-andhealth/ROHC%202014%20handouts/Bristol_Huntsman_HTTI.HCP%20Oct%2018%20B%20ppt%20final.p df. Accessed July 30, 2015. The United States Department of Labor. What are Child Labor and Forced Labor? 2015. http://www.dol.gov/ilab/child-forced-labor/What-are-Child-Labor-and-Forced-Labor.htm. July 30, 2015 United Nations Office of Drugs and Crime. Anti-human trafficking manual for criminal justice practitioners. Indicators of trafficking in persons. Published in New York. 2009. Printed in Vienna, Austria. http://www.unodc.org/documents/human-trafficking/TIP_module2_Ebook.pdf. Accessed July 30, 2015. Polaris Project, Trafficking Victims’ Protection Act (TVPA) Fact Sheet. 2008. http://www.rescue.org/sites/default/files/resourcefile/trafficking%20victims%20protection%20act%20fact%20sheet_0.pdf. Aug. 6, 2015. State of Michigan Attorney General Bill Scheuette. Human Trafficking Laws. 2015. http://www.michigan.gov/ag/0,4534,7-164-60857_60859---,00.html. Aug. 6, 2015.
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References •
Gu, Q., M.D.; Dillon, C., M.D.,; Burt, V., Sc.M., R.N.Centers for Disease Control and Prevention. National Center for Health Statistics Data Brief. Prescription Drug Use Continues to Increase: U.S. Prescription Drug Data for 2007-2008. Updated Sept. 2, 2010. http://www.cdc.gov/nchs/data/databriefs/db42.htm. Aug. 6, 2015.
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United States Department of State. Identify and Assist a Trafficking Victim. http://www.state.gov/j/tip/id. Accessed July 30, 2015.
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United States Department of State. Trafficking in Persons Report 2009. http://www.state.gov/j/tip/rls/tiprpt/2009/123126.htm. Accessed July 30, 2015.
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The Global Resource & Data base: Human Trafficking Search. Published 2012. Last updated 2015. http://www.humantraffickingsearch.net/typesoftrafficking.html. Accessed July 30, 2015. Child Soldiers International. Who are child soldiers? Last updated 2015. http://www.childsoldiers.org/faq.php. Accessed July 30, 2015. Kus, L. Fox 17. Child sex trafficking: Michigan authorities taking notice. Nov. 16, 2009. http://www.fox17online.com/news/fox-17-child-sex-traffickingmichigan,0,7052982.story. Aug. 6, 2015.
References •
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Human Trafficking Clinic University of Michigan Law School. A Survey of Human Trafficking in Michigan. Jun. 2011. http://www.law.umich.edu/clinical/humantraffickingclinicalprogram/Documents/A%20Survey%20of%20H uman%20Trafficking%20in%20Michigan.June%202011.pdf. Aug. 6, 2015. Lily Pad Haven, Inc. What is Human Trafficking? Published 2015. http://lilypad-haven.org/what-ishuman-trafficking. Accessed July 30, 2015. Clawson, H.J.; Dutch, N.; Soloman, A.; Goldblatt-Grace, L. Human Trafficking Into and Within the United States: A Review of the Literature. United States. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. Published August 2009. http://aspe.hhs.gov/hsp/07/HumanTrafficking/LitRev/index.shtml. Accessed July 20, 2015. Farley, M., Cotton, A., Lynne, J., Zumbeck, S., Spiwak, F., Reyes, M. E., Sezgin, U. (2003). Prostitution and trafficking in nine countries: An update on violence and posttraumatic stress disorder. Journal of Trauma Practice, 2, 33–74. United States Department of Homeland Security. Myths and Misconceptions. http://www.dhs.gov/bluecampaign/myths-and-misconceptions. Accessed July 30, 2015. National Human Trafficking Resource Center. What is Human Trafficking? Myths and Misconceptions. http://www.traffickingresourcecenter.org/what-human-trafficking/myths-misconceptions. Accessed July 30, 2015.
References •
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Rettner, Rachael; Senior Writer. Doctors Can Help Identify Child Sex Trafficking in the US. July 21, 2014. http://www.livescience.com/46908-child-sex-trafficking-victims-identify.html. Accessed July 31, 2015. Dovydaitis T. Human trafficking: the role of the health care provider. J Midwifery Womens Health. 2010 Sep-Oct;55(5):462 http://www.medscape.com/viewarticle/732991. Accessed July 31, 2015. Grace AM, Lippert S, Collins K, Pineda N, Tolani A, Walker R, Jeong M, Trounce MB, Graham-Lamberts C, Bersamin M, Martinez J, Dotzler J, Vanek J, Storfer-Isser A, Chamberlain LJ, Horwitz SM. Educating health care professionals on human trafficking. Pediatric Emergency Care. 2014 Dec;30(12):856-61. http://www-ncbi-nlm-nih-gov.proxy.lib.umich.edu/pubmed/25407038. Accessed July 31, 2015. Nuzzolese, E. DDS, Forensic Ondontologist. Journal of Forensic Ondontostomatology. Human Trafficking: Role of Oral Health Care Providers. International Dental Ethics and Law Society Congress. November 2014, Vol. 32, Sup. No.1. Pages 1-8. http://www.iofos.eu/Journals/JFOS%20sup1_Nov14/636.pdf. Accessed July 30, 2015. Innocents at Risk. Protecting Women & Children From Human Trafficking: Warning Signs. Washington, DC. 2006-2015. http://www.innocentsatrisk.org/human-trafficking/warning-signs. Accessed July 31, 2015. United Nations Office on Drugs and Crime. Human Trafficking Indicators. http://www.unodc.org/documents/human-trafficking/HT_indicators_E_LOWRES.pdf. Accessed July 31, 2015.
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References •
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Schuette, B, Michigan Attorney General. Human Trafficking “Red Flags” For health Care Professionals. http://www.michigan.gov/documents/ag/2012_-_HT_RED_FLAGS_Health_Care_Professionals_394611_7.pdf. Accessed July 31, 2015. Attorney General of Georgia. Red Flags for Physicians. http://law.ga.gov/3-red-flags-physicians. Accessed August 21, 2015. Cardea Family Planning National Training Center, Organizational Development and Research. Human Trafficking in the Family Planning Setting. September, 2011. http://www.cardeaservices.org/documents/Human_Trafficking_FINAL_Handout.pdf. Accessed August 21, 2015. Payne, C. Australasian Council of Women and Policing. Trafficking of Women and Children. http://www.aic.gov.au/media_library/conferences/2005-policewomen/payne.pdf. Accessed August 21, 2015 Department of Health and Human Services. Rescue & Restore Victims of Human Trafficking. Resources: Screening tool for victims of human trafficking. http://www.acf.hhs.gov/sites/default/files/orr/screening_questions_to_assess_whether_a_person_is_a_trafficking_victim_0.pdf . Accessed July 31, 2015. Thacker. SB., MD, M.Sc., Director. Centers for Disease Control and Prevention and U.S. Department of Health and Human Services. HIPAA Privacy Rule and Public Health. http://www.cdc.gov/mmwr/preview/mmwrhtml/m2e411a1.htm. Accessed August 21, 2015. United States Department of Health & Human Services. Office of Refugee Resettlement. An Office of the Administration for Children & Families. Fact Sheet: Sex Trafficking. http://www.acf.hhs.gov/programs/orr/resource/fact-sheet-sex-traffickingenglish. Accessed July 31, 2015. United States Department of Homeland Security. Human Trafficking. A Global Problem. http://www.ice.gov/humantrafficking. Accessed July 31, 2015.
Questions? A review of self-assessment questions will follow the question and answer session.
Self Assessment Questions 1) True or False. Human trafficking only involves women and children.
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Self Assessment Questions 2) Which of the following is an example of a “red flag” in the health care setting? 1. Victim is often escorted to and from appointments and escort may often talk for the patient 2. Presence of branding, scarring, or tattoo indicating ownership by someone 3. Cash payments 4. All of the above.
Self Assessment Questions 3) Which of the following is a warning sign of human trafficking in children? a) Outside playing with other children b) Regular attendance at school c) Reports they eat apart from other members in their family/home d) Appears shy.
Self Assessment Questions 4) True or False. Victims of human trafficking will always have signs of physical abuse.
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