‘We have a duty to respond’: HCA Healthcare’s Human Trafficking Awareness and Prevention Program

Every day, healthcare workers and public safety agencies interface with overt community epidemics such as drug trafficking, domestic violence, chronic illness and injuries.

But there is another epidemic plaguing our communities, one that is often hidden in plain sight: human trafficking.

HCA Healthcare is stepping up to help combat the silent epidemic through a new Human Trafficking Awareness and Prevention Program, comprised of education, training and situational awareness for our clinicians and colleagues.

“At the local level, we collaborate with law enforcement and community-based providers to identify, interact and intervene in situations where human trafficking is suspected,” Wargo adds. “By focusing on awareness and intervention, our colleagues can help human trafficking victims transition into a pathway of survivorship.”

HCA Healthcare has teamed up with the U.S. Department of Health and Human Services’ Office on Trafficking in Persons (OTIP) to provide online and in-person trainings to HCA Healthcare colleagues to inform and enhance the public health response to human trafficking. OTIP provides human trafficking training to professionals in healthcare, behavioral health, public health and social services settings through SOAR Online, which is administered by the National Human Trafficking Training and Technical Assistance Center (NHTTAC). The SOAR program teaches professionals how to:

• STOP: describe the types of trafficking and common risk factors
• OBSERVE: identify individual and indicators of human trafficking
• ASK: screen and identify individuals who may have experienced trafficking using a trauma-informed and person-centered approach
• RESPOND: address individual needs by coordinating across multidisciplinary stakeholders to deliver appropriate services

What is human trafficking?

The U.S. Department of Health & Human Services’ Office on Trafficking in Persons describes human trafficking as “a crime and public health concern that affects individuals, families, and communities across generations.” Also referred to as “modern slavery”, cases of human trafficking have been reported in all 50 states and individuals can be targeted for trafficking across any class, religious, cultural or ethnic group.

There are two types of trafficking in persons:

• Labor trafficking: individuals are compelled to work or provide services through the use of force, fraud or coercion.
• Sex trafficking: individuals are compelled to engage in commercial sex through the use of force, fraud or coercion. When a person under 18 years old is induced to perform a commercial sex act, it is a crime regardless of whether there is any force, fraud or coercion.

What are the signs that someone may be experiencing trafficking?

Trafficking can happen anywhere, from illicit markets to legal industries like agriculture, hospitality, construction or domestic services. While not all victims will show physical signs, the Office On Trafficking in Persons shares potential indicators:

Physical Health

• Frequent treatment for sexually transmitted infections
• High number of sexual partners
• Multiple pregnancies/abortions
• Exposure to toxic chemicals
• Dental issues
• Bruising and burns
• Signs of self-harm
• Weight loss or malnourishment
• Respiratory issues
• Suicide attempts
• Physical and sexual abuse

Behavioral Health

• Confusing/contradicting stories
• Inability to focus or concentrate
• Unaware of current date, location, or time
• Protects person who hurt them
• Minimizes abuse
• Guilt and shame about experiences
• Suicidal ideations
• Extreme timidity
• Aggressive, antagonistic, or defensive
• Heightened stress response
• Post-traumatic stress disorder
• Withdrawn
• Depressed

Social/Environmental

• Absent from school
• Failing grades
• Sudden increase in substance use
• Change in dress
• Age-inappropriate romantic partner
• Change in friends
• Repeat runaway
• Not able to speak for oneself or share information
• Evidence of being controlled
• Wears inappropriate clothing for the weather
• Lives at worksite
• Multiple people in cramped living space

How can healthcare professionals step up in the fight against human trafficking?

It is estimated that 67.6% of individuals who have experienced trafficking encountered a healthcare professional during their trafficking experience.

Healthcare providers play an important role in identifying and treating victims of trafficking. Often, victims of human trafficking suffer injuries or illnesses requiring visits with a clinician. These health issues include sexually transmitted diseases, physical injuries, burns, anxiety, suicidal ideation, substance abuse, HIV/AIDS, depression, sexual violence, malnutrition, skin conditions and dental injuries. Survivors of human trafficking frequently require trauma-related mental health services.

NHTTAC’s SOAR framework is a trauma-informed, culturally and linguistically appropriate response to human trafficking. It provides a quick mental reference for our healthcare professionals to keep in mind the best way to help individuals who are at risk, currently experiencing or have experienced trafficking.

“By equipping our caregivers and hospitals with accessible NHTTAC tools and training, we are providing a potential lifeline to human trafficking victims and survivors that access HCA Healthcare’s facilities,” said Wargo.

All courses in the SOAR Online curriculum are available to HCA Healthcare’s more than 283,000 colleagues in HealthStream.

Working with community partners to fight human trafficking  

No organization or sector can effectively fight human trafficking alone. It requires a community response. HCA Healthcare, the HCA Healthcare Foundation, and our colleagues are proud to partner with law enforcement, government, healthcare, business and community organizations to help ensure that every human has a chance to live free.

A few examples of how HCA Healthcare affiliate hospitals are nurturing meaningful relationships with local community partners include:

Forensic nurse examiners at affiliate Mission Health in North Carolina are specially trained to provide comprehensive care for victims of human trafficking, sexual assault and abuse, domestic violence/intimate partner violence and physical assault. The nurse examiners lead a co-located clinic at the Buncombe County Family Justice Center. Mission Health sexual assault nurse examiner (SANE) lead Jackie Maillet was recognized by the American Red Cross with a 2022 Western North Carolina Heroes Award for her role at the clinic and for bringing trauma-informed approaches to the emergency department.

Mission Health also partners with Our VOICE, a non-profit crisis intervention and prevention agency that serves as Buncombe County’s anti-sexual violence and anti-human trafficking agency.

From HCA Healthcare’s headquarters in Nashville, Tennessee, the HCA Healthcare Foundation supports the fight against human trafficking through grantmaking, sponsorships and volunteering. We have an active relationship with Thistle Farms, a nonprofit organization dedicated to providing healing and hope to women survivors of trafficking, prostitution, and addiction. Another community organization that we partner with is End Slavery Tennessee, who advocates for human trafficking victims, educates communities across the state and the region, and informs legislators about the critical need to enact tougher laws so that traffickers are duly prosecuted.

In Wichita, Kansas affiliate Wesley Healthcare is working with Hope Ranch for Women, a nonprofit organization offering faith-based equine-assisted learning, mentoring and a residential home to empower and heal women who have been exploited and abused. A Wesley Healthcare nurse colleague has stepped up in the fight and regularly volunteers her time with the organization.

In Florida, HCA Florida Aventura Hospital has developed a local human trafficking program and HCA Florida JFK Hospital has helped to identify trafficking victims within an addiction stabilization unit.

Help and resources

The National Human Trafficking Hotline is a 24/7, confidential, multilingual hotline for victims, survivors and individuals with human trafficking concerns.

Call: 1-888-373-7888

Text: “BeFree” (233733)

Live chat: humantraffickinghotline.org