Anti-Trafficking Policy Developments Impacting Health Care Providers

Publication Date: March 29, 2016

Dr. Hanni Stoklosa's Remarks to the HHS Task Force to Prevent and End Human Trafficking on March 29, 2016

Thank you for inviting me to discuss Anti-Trafficking Policy Developments Impacting Health Care Providers.

I speak to you today with two hats, both as an emergency medicine physician at Harvard Medical School and leader of HEAL Trafficking.

HEAL Trafficking, founded in the fall of 2013,’s vision is a world healed of trafficking and our mission is to unify and mobilize interdisciplinary professionals to shift the anti-trafficking paradigm toward approaches rooted in public health and trauma-informed care. Our practicing professional members across the United States tackle issues at the crux of public health and trafficking, including Education and Training, Protocol Development, Research, Direct Services, and Prevention.

Every day, nurses and doctors across the country are putting their hands on trafficking victims without realizing it. We know that up to 88% of human trafficking survivors interface with healthcare. Yet, most clinicians are not aware of the presence of human trafficking victims within their midst. There should be “no wrong” door for trafficking survivors to enter into healthcare. Whether they show up on a labor and delivery floor, in a community health clinic, or a detox center, all victims of trafficking should be identified.

Over the last few years, we have seen progress in awareness of trafficking among clinicians. HEAL members have driven efforts from within the medical community, including the Institute of Medicine’s report, professional society policy statements such as the American Medical Association and the American Public Health Association statement. Moreover, some states have mandated human trafficking education for clinicians and federally, the SOAR Initiative and legislation such as Justice for Victims of Trafficking Act of 2015 Title VII have been critical in creating awareness in the medical community.

However, as I imagine most of you in the room would agree, awareness is really just the first step. Healthcare must go far beyond awareness to embrace a broader public health approach. We must combat the upstream risk factors and comprehensively tackle the downstream squalene. We need to focus on trafficking as the public health epidemic that it is, and not just a criminal justice issue.

A recent patient in my Boston emergency department illustrates emerging trends we are seeing in trafficking on the frontlines.

Beth (not her real name) was a twenty year old female, hooked on heroin and was being discharged from a detox facility when she met a man who promised to provide a consistent supply of heroin. Thus began a nightmare for Beth. She was locked in a motel room in Rhode Island, forced to service over 200 men. When she finally escaped, her first stop was my emergency department. She came to my hospital to escape trafficking- for treatment of her depression and heroin addiction and for medical attention. She waited, and waited for an opening in a dual diagnosis facility that would be able to help her with her both addiction and depression, the very things that had led her to be trafficked in the first place. But, when there were no beds in sight Beth decided to take her chances on her own. She walked out of our emergency department, back out into the cold.

We had a window of opportunity and we lost it. Beth’s story teaches us a few key lessons.

First, trafficking is tied directly to the opioid epidemic.

Second, trafficking is a wakeup call for healthcare to become harmonized and trauma- informed.

Third, trafficking requires robust mental health and addiction treatment.

First, domestic sex trafficking is tied directly to the opioid epidemic. Over 50% of the trafficking victims in my emergency department are hooked on heroin, just like Beth. And through the HEAL Trafficking network, I know that we are not alone in the country. Without the addiction treatment facilities needed for trafficked persons in hand, we risk releasing them right back into the hands of their traffickers.

I have seen firsthand how the power of addiction combined with the coercion of a trafficker is a lethal combination.

Secondly, trafficking is a wakeup call for healthcare to become trauma-informed. Healthcare sees survivors of violence across the lifespan, including child abuse, sexual abuse, intimate partner violence, gang violence, elder abuse, and human trafficking. Many patients are victims of one or more types violence, but without harmonization among care systems, and trauma- informed approaches we risk missing critical opportunities for intervention.

Finally, we need robust mental health treatment services. Trafficking creates lifelong scars of the deepest kind.  In a recent study of over 100 women who had been trafficked, 89% suffered from depression and over half suffered from PTSD. I have seen too many trafficking survivors come back to the emergency department, after trying to kill themselves because they could not take the mental torture any more. Mental health treatment for survivors must match the depth and breadth of the psychological damage they have experienced.

Thanks to critical governmental and private sector initiatives, clinicians are beginning to recognize trafficking victims. But they are being identified toward what end? To truly provide healing and restoration for trafficked patients we need to dedicate specific resources to address the links to the opioid epidemic, improve interconnected trauma- informed health care delivery, and provide quality mental health treatment for trafficking survivors. We need those resources in hand at the time of identification, or more patients will end up like Beth- back out in the cold.

Thank you. Hanni Stoklosa, MD, MPH

The opinions and conclusions expressed in this testimony are the author’s alone and should not be interpreted as representing those of Brigham and Women’s Hospital or Harvard Medical School.

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