Human Trafficking Awareness for Healthcare Professionals
18-minute refresher · For: All health professionals and staff who may encounter patients in clinical settings, including emergency, primary care, urgent care, obstetrics and gynecology, pediatrics, dental, behavioral health, pharmacy, laboratory, and front-desk personnel.
- Define sex trafficking and labor trafficking under federal law.
- Recognize potential indicators of trafficking in healthcare encounters.
- Apply a trauma-informed, patient-centered approach when trafficking is suspected.
- Identify appropriate response pathways, including the National Human Trafficking Hotline and mandatory reporting for minors.
What Is Human Trafficking?
Under the federal Trafficking Victims Protection Act of 2000 (TVPA), as amended, severe forms of trafficking in persons include:
- Sex trafficking: the recruitment, harboring, transportation, provision, obtaining, patronizing, or soliciting of a person for a commercial sex act induced by force, fraud, or coercion, or in which the person induced to perform the act is under 18 years of age. For minors, force, fraud, or coercion does not need to be shown.
- Labor trafficking: the recruitment, harboring, transportation, provision, or obtaining of a person for labor or services through force, fraud, or coercion for the purpose of involuntary servitude, peonage, debt bondage, or slavery.
Trafficking does not require crossing a border or any movement at all. It affects people of all ages, genders, and backgrounds, including U.S. citizens and foreign nationals. Labor trafficking can occur in industries such as agriculture, domestic work, restaurants, construction, and other settings.
Why Healthcare Professionals Matter
People experiencing trafficking may seek healthcare for injuries, infections, reproductive health needs, chronic conditions, or mental health concerns. A healthcare visit can be one of the few times a person is seen by a professional outside the trafficker's direct control.
The HHS Administration for Children and Families, Office on Trafficking in Persons (OTIP), offers the SOAR to Health and Wellness training to help professionals Stop, Observe, Ask, and Respond to human trafficking. The goal is not to investigate or rescue, but to recognize, respond in a patient-centered way, and connect people with help they choose.
Potential Indicators
No single sign proves trafficking, and many indicators can have other explanations. Look for patterns. Potential indicators described by OTIP and the National Human Trafficking Hotline include:
- An accompanying person who insists on staying with the patient, speaks for them, or controls their identification documents or money.
- The patient appears fearful, anxious, submissive, or avoids eye contact, especially in the presence of the companion.
- Inconsistent or scripted history, or a history that does not match the injuries.
- Lack of knowledge of their own address or the city they are in.
- Signs of physical abuse, untreated injuries, or delayed care.
- Tattoos or branding that may indicate ownership.
- Repeated sexually transmitted infections, pregnancies, or pregnancy terminations.
- Work-related injuries without protective equipment, or unusually long work hours.
- Statements about owing a large debt to an employer, or being unable to leave a job.
- For minors, signs such as being unenrolled in school, having an older partner, or having unexplained money or gifts.
A Trauma-Informed Approach
If you have concerns, focus on the patient's safety, dignity, and choices:
- Create privacy: find a routine reason to speak with the patient alone, such as a policy that certain parts of the exam are conducted privately.
- Use a professional interpreter, never the accompanying person, for patients who need language assistance.
- Ask open-ended, non-judgmental questions, such as whether they can come and go as they please, whether anyone holds their documents, or whether they have been threatened or forced to do anything they did not want to do.
- Explain confidentiality and its limits, including any mandatory reporting requirements, before sensitive disclosures where possible.
- Do not confront the suspected trafficker, and do not try to physically remove a patient from the situation yourself.
- Respect autonomy: adults may not be ready to accept help. Offer resources discreetly, provide needed medical care, and leave the door open for future visits.
Document objectively according to your organization's policy and follow your facility's human trafficking or abuse response protocol, which may involve social work and security.
Responding and Reporting
National Human Trafficking Hotline: call 1-888-373-7888, text 233733, or use the online chat at humantraffickinghotline.org. The hotline is confidential, available 24 hours a day, 7 days a week, in many languages. It can connect survivors to services and can take tips. With an adult patient's consent, you can help them call; you can also call the hotline yourself for guidance.
Immediate danger: if anyone is in immediate danger, call 911 and follow your facility's security procedures.
Minors: suspected trafficking of a person under 18 is a form of child abuse. Follow your state's mandatory reporting requirements, which typically involve reporting to child protective services and/or law enforcement, and follow your organization's policy.
Adults: reporting requirements for adults vary by state and circumstance. In general, report with the patient's informed consent unless a legal requirement or immediate safety concern applies. Consult your organization's policy and legal or compliance resources.
Organizational Preparedness
Healthcare organizations can support staff by:
- Adopting a written human trafficking response protocol.
- Training staff on indicators and trauma-informed responses.
- Ensuring access to professional interpreters and social work.
- Building relationships with local service providers and anti-trafficking organizations.
- Posting hotline information discreetly, such as in restrooms, where patients may see it privately.
ICD-10-CM includes codes for suspected and confirmed exploitation, including forced labor and sexual exploitation, which can help organizations understand needs when used in accordance with official coding guidelines and privacy considerations.
Caring for Yourself and Your Team
Encounters involving exploitation can be distressing for healthcare workers. Debrief with colleagues or supervisors after difficult cases, use employee assistance resources when needed, and remember that your role is to recognize, respond with compassion, and connect patients with resources. Survivors often make decisions about seeking help over time, and a respectful encounter may matter even if the patient does not accept assistance that day.