Senate passes human trafficking bill

Excerpted from "Senate Passes Human Trafficking Bill With Abortion Restrictions On Victims," Huffington Post. April 22, 2015 — The Senate passed a sex trafficking bill on Wednesday after a bitter, weeks-long fight over an anti-abortion provision tucked into it. The Justice for Victims of Trafficking Act passed 99-0.

At its core, the bill has had broad support. It provides resources to law enforcement officials and collects fees from sex traffickers that go into a new fund for victims. But Republicans included language subjecting the victim fund to the Hyde Amendment, the federal provision that bars the use of taxpayer funds for abortions except in cases of rape and incest. Democrats refused to let the bill advance over the Hyde language, particularly because, for the first time, it would have applied to non-taxpayer funds.

It took a month of back-and-forth between Sen. John Cornyn (R-Texas), the bill's author, and Sen. Patty Murray (D-Wash.) to find a compromise. They settled on creating two funding streams in the bill. One collects fines from traffickers and uses them for survivor services, excluding health care. That stream doesn't include Hyde restrictions. The second one comes from community health center funds already subject to the abortion limits.

The deal lets both parties walk away with a solid talking point: Democrats can say they prevented an expansion of Hyde, and Republicans can say they prevented victims of sex trafficking from using federal funds for abortions.

Commentary

CMDA Health Consultant on Human Trafficking Jeffrey J. Barrows, DO, MA (Bioethics): “This legislation passed unanimously by the Senate focuses on the trafficking of children under age 18 and will provide many resources should it become law. There are provisions that apply to the healthcare profession, especially those who are “first responders” and healthcare officials. The bill provides grants to train professionals who commonly encounter victims of trafficking on how to identify victims of human trafficking, address their unique needs and facilitate their rescue. Emergency department personnel are a prime example.

“One study has shown that almost 88 percent of victims of domestic sex trafficking regularly encounter healthcare professionals while being trafficked, especially those working within emergency departments.¹ Unfortunately, fewer than three percent of emergency department personnel have been trained on human trafficking and so these victims are rarely identified.²

“CMDA’s Commission on Human Trafficking has addressed the issue of training by developing a series of online educational modules on human trafficking specifically designed for the healthcare profession which can be found at www.cmda.org/tip. In addition, the commission is planning an in-depth training seminar later this year in Atlanta on November 13-14. More information will be forthcoming and registration will be open to anyone who desires to learn more about the interface between healthcare and human trafficking. Any questions about CMDA’s work against human trafficking can be addressed to humantrafficking@cmda.org.

¹Lederer L, Wetzel, CA. The Health Consequences of Sex Trafficking and Their Implications for Identifying Victims in Healthcare Facilities. The Annals of Health Law 2014; 23:61-91.
²Chisholm-Straker M, Richardson LD, Cossio T. Combating Slavery in the 21st century: The role of emergency medicine. J Healthcare for Poor and Underserved 2012; 23:980-987.

Resources

CMDA’s Human Trafficking Ethics Statement
Commission on Human Trafficking
Human Trafficking Continuing Education

President proclaims "National Slavery and Human Trafficking Prevention Month"

Excerpted from "January is National Slavery and Human Trafficking Prevention Month," U.S. Department of Health and Human Services blog, January 6, 2014, by George L. Askew, MD, FAAP, Chief Medical Officer: Human trafficking is a form of modern-day slavery. Victims of human trafficking are subjected to force, fraud or coercion for the purpose of commercial sex, debt bondage or forced labor. It is estimated that more than 20 million women, men and children around the world are victims of human trafficking. Among the diverse populations affected, children are at particular risk for sex trafficking and labor trafficking.

The Department of Health and Human Services (HHS) is the federal agency responsible for providing victims and survivors of human trafficking access to benefits and services needed to help them restore their lives and achieve self-sufficiency. The Federal Strategic Action Plan on Services to Victims of Human Trafficking in the United States calls for coordinated, effective, culturally appropriate and trauma-informed care for victims and survivors.

Trafficking victims and survivors may suffer from an array of physical and psychological health issues stemming from inhumane living conditions, poor sanitation, inadequate nutrition, poor personal hygiene, brutal physical and emotional attacks at the hands of their traffickers, dangerous workplace conditions, occupational hazards and general lack of quality health care.

Preventive health care is virtually non-existent for these individuals. Health issues are typically not treated in their early stages, but tend to worsen until they become critical, even life-endangering situations. In many cases, health care is administered at least initially by an unqualified individual hired by the trafficker with little if any regard for the well-being of their “patients” — and even less regard for disease, infection or contamination control.

A few months ago in response to the Federal Strategic Action Plan on Services to Victims of Human Trafficking in the United States, our office collaborated with the HHS Office of Women's Health to develop a pilot project that will create a national technical working group to strengthen coordination of medical and health system responses to human trafficking. Specific actions include:

• Supporting the development of protocols to manage and provide services to victims of human trafficking
• Training and educating health care providers to recognize signs of human trafficking, identify potential cases, and respond effectively
• Creating a referral mechanism for healthcare professionals to inform and connect with law enforcement agencies, social service providers, and community-based organizations
• Promoting effective, culturally relevant, and trauma-informed care to improve the short-term and long-term health of victims.

Commentary

CMDA Health Consultant on Human Trafficking and Direct of U.S. Training for Hope for Justice Jeff Barrows, DO, MA: “I was honored to serve on the technical working group mentioned by Dr. Askew that was established by the Department of Health and Human Services in response to the Federal Strategic Action Plan on Human Trafficking. This past year, that technical working group developed a two-hour training for healthcare professionals on human trafficking and piloted that training in five different locations across the country.

“There is need for standardized training curriculum on human trafficking that is evidence-based and shown to be effective in helping identify victims of human trafficking within the healthcare setting. A study published last year found that almost 88 percent of victims of domestic sex trafficking encountered a healthcare professional while being trafficked.¹

“The CMDA Commission on Human Trafficking is about to undertake a randomized survey of a portion of the membership of CMDA regarding their knowledge of human trafficking. This survey is being conducted in association with Liberty University and is an effort to add to the limited existing data regarding healthcare professional knowledge of human trafficking. A survey of emergency room personnel in 2012 found that less than 6% were confident in their ability to identify a victim of human trafficking, while only 2% had received any formal training on human trafficking.²

Action

1. If you think you have come in contact with a victim of human trafficking, call the National Human Trafficking Resource Center at 888-373-7888. For more information on human trafficking, visit www.acf.hhs.gov/trafficking.
2. If you are chosen to participate in this survey, please help us gather this critical data by taking the few minutes necessary to complete the survey. It will help us develop evidence-based training curricula that will eventually lead to victims being identified and freed.
3. Equip yourself to recognize and respond to victims of human trafficking by taking CMDA's CME-credit online course at www.cmda.org/TIP.

¹ Lederer, L. and Wetzel, C.A. “The Health Consequences of Sex Trafficking and Their Implications for Identifying Victims in Healthcare Facilities.” (2014) The Annals of Health Law 23:1. 61-91.
² Chisholm-Straker, M., Richardson, LD., and Cossio, T. “Combating Slavery in the 21st century: The role of emergency medicine.” (2012) J Healthcare for Poor and Underserved 23:980-987.

Resources
CMDA resources on human trafficking

Human trafficking victim: Healthcare professionals can help

Excerpted from "Kidnap Victim Addresses Human Trafficking Forum," ABC News, August 14, 2014, - A woman who was held captive for nine months has underscored the importance of work performed by health care professionals, law enforcement and social workers to rescue and support kidnap victims. Elizabeth Smart-Gilmour told a South Dakota forum on Wednesday that such work "makes a difference" in the fight against human trafficking and sexual abuse.
"People like you brought me back," Smart-Gilmour told the audience.

Smart-Gilmour was taken from her Salt Lake City bedroom in June 2002 at age 14 and held for nine months. Now 26, she described her capture and the repeated sexual assaults she endured. She told how she was moved from Utah to California and constantly threated with death if she tried to escape.

She stressed that authorities must have protocols in place to deal with rescued victims. Smart-Gilmour recalled how she was handcuffed, taken to the police station and left in a "little room with no windows" right after police officers found her. The situation, she said, did not make her feel comfortable. Since her rescue, she has started the Elizabeth Smart Foundation to protect children and educate them about violent and sexual crimes.

Commentary

CMA VP for Govt. Relations Jonathan Imbody: “Last week I attended in Atlanta a roundtable discussion group, led by trafficking expert Dr. Laura Lederer, focused on strategies to help healthcare professionals recognize and respond to victims of human trafficking. I began working with Laura over a decade ago when she was helping to lead the U.S. State Department's fight against trafficking. She was one of the first to recognize the tremendous potential for healthcare professionals to recognize and respond to human trafficking victims, who often visit healthcare facilities during their captivity.

“Along with CMDA Health Consultant on Human Trafficking Dr. Jeff Barrows, we engaged the White House, the Centers for Disease Control, the Department of Homeland Security, the AIDS ambassador and many others in an effort to get the government to implement programs to encourage the healthcare community to respond to opportunities to help human trafficking victims. I remember a frustrating meeting in the White House with CDC Director Dr. Julie Gerberding and the President's advisors, trying to convince her of the need while she questioned the data supplied by the FBI.

“Since then, more research data has proved the point, and most recently a published research project led by Dr. Lederer highlights the tremendous opportunities for healthcare professionals to make a difference. A comprehensive study found that:

• Of victims who answered the questions about their contact with healthcare (N=98), 87.8 percent had contact with a healthcare provider while they were being trafficked.
• By far the most frequently reported treatment site was a hospital/emergency room, with 63.3 percent being treated at such a facility. Survivors also had significant contact with clinical treatment facilities, most commonly Planned Parenthood clinics, which more than a quarter of survivors (29.6 percent) visited. More than half (57.1 percent) of respondents had received treatment at some type of clinic (urgent care, women's health, neighborhood or Planned Parenthood).
• Pregnancy, miscarriage and abortion were all common experiences for survivors in the study. More than half (55.2 percent) of the 67 respondents who answered reported at least one abortion, with 20 respondents (29.9 percent) reporting multiple abortions; survivors in this study similarly reported that they often did not freely choose the abortions they had while being trafficked.

“You can make a difference. Your education on how to recognize and respond to victims of human trafficking can mean the difference between life and death, freedom and slavery for a victim you may encounter. Please consider taking the CME-credit online course below.”

Action
Use CMDA's online modules for human trafficking education to obtain CME credit while equipping yourself to recognize, respond and treat victims of human trafficking.

Resources
"Health consequences of sex trafficking and their implications for identifying victims in healthcare facilities" - published research by Dr. Laura Lederer

CMDA's online modules for human trafficking education

Additional resources on human trafficking from CMDA

To learn more about a new CMDA Commission on Human Trafficking to help prepare healthcare professionals to identify and assist victims of human trafficking contact Dr. Jeffrey Barrows at: jeff@abolitioninternational.org.

CMDA human trafficking expert teaches doctors and students

Excerpted from "Doctor on a mission to combat modern slavery," (Ky.) Courier-News, August 31, 2013 - As he talked to Louisville doctors and medical students last week, Ohio physician Jeffrey Barrows said he saw familiar expressions on their faces. Shock. It was the same response he had when he began learning about modern slavery less than a decade ago.

Barrows had worked for years with the Christian Medical & Dental Associations, conducting short-term educational trips throughout Asia and Africa. Through a contact with the State Department, Barrows said, he was asked to do research into the health effects of human trafficking as it relates to the global spread of HIV and AIDS.

“The more I read, the more I was shocked,” Barrows, an obstetrician and gynecologist, recalled in an interview Aug. 23 after his Louisville lecture. Many people are still not aware, he said — and his fellow doctors can play a vital role in combating it.

“Of all the sectors within society, health care is one of the most likely to encounter these victims,” he said. Research indicates that a quarter to a half of trafficking victims encounter health care professionals at some point when they are enslaved, Barrows said.

Barrows spoke at Norton Hospital at the University of Louisville Department of Pediatrics Grand Rounds, a continuing-education lecture attended by about 160 students, doctors and other social-service and government representatives. Barrows spends his time educating health care professionals on the signs of trafficking and promoting the development of homes that help recovering victims. He is vice president of Abolition International, a group that works to end sex slavery.

Emergency-room staff and other medical professionals need to watch for the signs of trafficking, Barrows said — just as they have been trained on signs of domestic violence and child abuse.

“Getting the word out is part of the puzzle, getting the people to understand this is happening,” Barrows said. Otherwise, “they’ll encounter a patient and they’ll walk away saying, ‘Something strange is going on, but I don’t know what it is.’”

Warning signs, he said, include:

The victim being accompanied by a highly controlling person — who might even be a family member.
The body language of the patient indicating fear of the accompanying person.
Tattoos indicating a handler’s street name — often a brand of “ownership” by the trafficker.
Signs of abuse.
For sex workers, multiple sexually transmitted diseases.
For manual laborers, such injuries as back trauma or hearing loss.
The victim may also be unaccountably silent on some issues — such as why he or she waited until symptoms became severe to seek medical help.

Commentary

CMDA Health Consultant on Human Trafficking Jeffrey J. Barrows, DO, MA (Bioethics) – “Dr. David McLario, a CMDA member, is on staff at Louisville Children’s hospital and made the arrangements for this presentation. He also did an excellent job organizing a symposium afterward to develop a protocol for their ED to respond to trafficking victims. His reward was encountering a patient the next day who, with further investigation, may turn out to be a victim of trafficking.

“Consider following his example by learning about trafficking and developing a strategy to respond. Every healthcare professional working with patients needs to be educated on human trafficking. Limited studies show between 28 to 50 percent of trafficking victims encounter a healthcare professional while being trafficked.

“CMDA has an excellent educational resource available online at cmda.org/tip. It’s even free if you don’t take the available CME credits. If you need assistance in developing a response strategy, contact me at jeff@abolitioninternational.org.”

Resources

CMDA human trafficking page

Action Take the CMDA education course, optionally with Category One CME credit, on human trafficking.

Trafficking in the USA hits close to home

Excerpted from "Sex trafficking in the USA hits close to home," U.S.A. Today, by Yamiche Alcindor. September 27, 2012--Asia Graves looks straight ahead as she calmly recalls the night a man paid $200 on a Boston street to have sex with her. She was 16, homeless, and desperate for food, shelter and stability. He was the first of dozens of men who would buy her thin cashew-colored body from a human trafficker who exploited her vulnerabilities and made her a prisoner for years. "If we didn't call him daddy, he would slap us, beat us, choke us," said Graves, 24, of the man who organized the deals. "It's about love and thinking you're part of a family and a team. I couldn't leave because I thought he would kill me."

By day, she was a school girl who saw her family occasionally. At night, she became a slave to men who said they loved her and convinced her to trade her beauty for quick cash that they pocketed. Sold from Boston to Miami and back, Graves was one of thousands of young girls sexually exploited across the United States, often in plain sight. A plague more commonly associated with other countries has been taking young victims in the United States, one by one. Though the scope of the problem remains uncertain -- no national statistics for the number of U.S. victims exist -- the National Center for Missing and Exploited Children says at least 100,000 children across the country are trafficked each year.

Globally, the International Labor Organization estimates that about 20.9 million people are trafficked and that 22 percent of them are victims of forced sexual exploitation. The growing number of human trafficking cases handled by U.S. Attorney MacBride's office -- 14 in the last 18 months -- reflects the domestic trend, experts say. The familiar echo of these crimes reaches the other side of the country, too, says Alessandra Serano, an Assistant United States Attorney for the Southern District of California. "You can sell drugs once," she said. "You can sell a girl thousands of times."

Since 2006, the U.S. Department of Education has focused on the problem and worked on training with several schools, said Eve Birge, who works for the agency's Office of Safe and Healthy Students. In doing so, they collaborate with the White House, the FBI, the Departments of State and Justice as well as other agencies. "For a lot of these kids, school can be the only safe place they have," Birge said. Click here to read full article.

CMDA Member and Founder of Gracehaven, Jeff Barrows, DO: “When the average person hears the words ‘human trafficking,’ they first of all think of women and girls being sold for sex in other countries like Thailand or Cambodia. Most individuals don’t realize that trafficking is happening right here in the United States in every major city. The most common form of trafficking in the U.S. is child sex trafficking of minors under the age of 18. The story of Asia in this article is being repeated all across the United States in every state! Like Asia, most of these victims come out of abusive/neglected homes.

“While it is good that President Obama recently drew attention to this horrible plague, the announced $6 million grant program is hardly enough to have a significant impact on the tremendous need for specialized services. Currently there are less than 200 specialized beds for 100,000 victims of child sex trafficking. Physicians and dentists have a major role in identifying these victims while they are being trafficked. Some important identifiers mentioned in the article are:

• Signs of physical abuse
• Truancy
• Homeless youth
• Sudden ability to possess expensive items
• Older boyfriends or girlfriends
• Frequent travel

“In addition, physicians and dentists are needed to provide the medical and dental care these victims need after they are freed. CMDA has a Trafficking in Persons Task Force that is developing a 11-part human trafficking training curriculum that provides continuing education credit and can be found online here."

Human Trafficking Resource Page
Human Trafficking Continuing Education
Human Trafficking - Trade of Innocents Trailer