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Human Trafficking: Insights From a Forensic Nurse Examiner

09/14/18

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Sherri Mason, MSN, FNP-C, Senior Consultant, Clinical Advisory Solutions and Shannon Berkeley-Scott, BSN, RN, CEN, SANE-P, Forensic Nurse Examiner

Several years ago, a 16-year-old girl was brought to the emergency department at Mary Washington Hospital in Fredericksburg, Va. for care. Police officers had found her in a local motel room after she had been kidnapped from a bus stop in North Carolina. The investigation showed she was being forced into prostitution and trafficked between Maryland and Virginia.

While at the hospital, a forensic nurse examined her and subsequently testified at the trial of her “handlers,” when the defendants were sentenced to lengthy prison terms. For the ED staff at Mary Washington Hospital, this was their first known case of human trafficking, and it made the department realize their communities were being affected. It was no longer something that happened to someone else, to other communities, or was someone else’s problem.

It was also an important personal moment for Shannon Berkeley-Scott, forensic nurse examiner and coordinator of the department at Mary Washington Hospital. She learned early on the role forensic nurses played in the care of victims of violent crime and she knew the career path she had chosen was the right one.

A few months ago, I wrote a blog on anti-human trafficking that received a lot of interest from Vizient members and other caregivers. Given Shannon’s role and commitment to helping other hospitals more effectively assist these patients when they come for care, I asked her to provide some insights into the barriers programs face and how to overcome them.

Where do you start in setting up an intervention program to help victims?

When we were researching the topic, we learned that a large percentage of human trafficking victims will seek medical help at some point during their ordeal and, more than likely will come to the ED – in fact, as many as 63 percent of victims reported having been seen in an ED while they were being controlled by their traffickers. For this reason, we decided the ED staff needed to be the educated first. To accomplish this, we created a curriculum that consisted of basic how-to and what’s-next information. We taught them not only how to identify victims but what needs to be done next. Do they need to contact law enforcement? Does the patient want a forensic exam done? Is their handler with them? If so, what needs to be done to keep the patient safe? When caring for this population, there are so many factors to consider, and we wanted to ensure staff were prepared and had the tools and processes to properly offer assistance to victims.

What types of trafficking victims do you normally encounter in your hospital?

We are confident we’ve had several different types of victims in our ED. Our staff has been trained on how to identify them and, because of this, they have requested our services on several occasions. However, as we know, many victims refuse to identify themselves as such and/or, for a plethora of different reasons, they do not want assistance. That’s why it’s so difficult to positively identify and help these victims.

What barriers did you encounter?

The biggest barrier is when those who need our help the most can’t, or won’t, accept it. Some are afraid of the consequences by their handlers if they cooperate with us. Some may be afraid if they don’t go back to their handlers, they will never see their families again. Some are even afraid of those trying to help them. They may not trust law enforcement or medical personnel. Some may feel they have a better life in the situation they are in than they had before they were trafficked. A teenager who has fled an abusive home may not disclose her situation for fear of being returned. Each of these examples is a huge incentive for many victims to keep silent.

In addition to the barriers put up by victims, many hospitals are challenged to have appropriate staffing in the forensic services department 24/7 to help these patients. Without those services in place, victims may not be identified and assisted when the opportunity presents itself. At Mary Washington, a 451-bed, Level II trauma center, we currently have four full-time nurses who see trafficked patients, as well as those who have encountered domestic violence, child abuse and other, more common reasons for visiting the emergency department. There is a great deal of overlap in dealing with trafficking versus other types of abuse but there still remains elements unique to each type of encounter. To maintain optimal 24/7 coverage in a facility of this size, six full-time nurses would be preferable.

Do you have community partners in law enforcement, social work or at other hospitals?

We are engaged with police departments, sheriffs’ offices, commonwealth’s attorney offices, social service departments and victim advocacy centers in multiple jurisdictions. We use a multidisciplinary team model, meaning when a case comes in, we work closely together to gather information from the victim in a cohesive way to help minimize further trauma. We use this model for most of our forensic cases, not just those involving human trafficking.

What were the greatest successes in planning and establishing your program?

Several amazing things have come from adding this population to those that the forensic services department care for. First, the more I learned about human trafficking, the more I learned about others who are as passionate about fighting for these victims as the forensic team at Mary Washington Hospital. We can learn from each other to speed progress in improving how we work with victims to get them the assistance they need.

Second, we saw an opportunity to educate. Once the staff was educated in the basics, we immediately noticed an increase in requests for consults. I had one nurse call me and say, “I sat through your class yesterday, and I think this girl may be a victim of human trafficking.” She asked me to talk to her. I was able to speak to her alone; and, although I was convinced she was being trafficked, she denied it. However, I took the opportunity to tell her of her options in reporting. I gave her phone numbers and pamphlets. I put them in the bottom of her bag so the man with her would not see them. I will never know if she truly was being trafficked or if she ever sought help. But, I know I did all I could to try and help her.

Finally, and most importantly, it has raised community awareness. I have given the same educational class to several local first-responder departments. It seems like once word got out that human trafficking is real, people wanted to learn more. And, I love that! As long as people will listen, I will continue to talk about it.  

What are your next targets or goals for the program?

I would love to see our educational offerings to staff expand. Victims of sexual assault, child and elder abuse, and domestic violence also visit the ED for care and may not want to disclose how they received their injuries. I believe the key is staff education. The more we know, the more empowered we become. Whether we are empowered to help ourselves or to help others, it doesn’t matter. What matters is we are helping these victims.

For more information about human trafficking and ways you can make a difference, visit the human trafficking hotline here. You may also contact Sherri Mason for assistance in identifying available resources or training. To report suspected human trafficking, call 866-347-2423.

About the authors. Sherri Mason’s 25 years of experience in the health care industry include time spent in critical care, cardiac cath lab, interventional radiology and emergency department practice; clinical trial and IRB membership management; and medical-legal and hospital consulting. She has been published as a contributing textbook author for health information management, medical assisting and legal aspects of nursing; and guided implementation and development of new clinical programs involving research and cardiovascular services. Mason is a member of American Association of Nurse Practitioners and holds certification as a family nurse practitioner.

During her nearly 15 years with the Mary Washington Hospital, Shannon Berkeley-Scott has practiced as a phlebotomist, as well as an emergency department and trauma nurse. Before these roles, she spent a decade as a flight attendant with Continental Airlines. Scott holds a bachelor of science in nursing from Kaplan University.

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