Healthcare workers need more knowledge and training in recognizing a trafficking victim.1,2,9 There are recent studies in the medical literature, specifically in pediatric nursing and nurse practitioner literature, suggesting that the recognition of human trafficking should be a part of the medical literature and that training in the area should be a part of the curriculum.2,9,10,28 Currently, there is little information in the dental or dental hygiene literature and most is mentioned along with child abuse. As we know, many patients visit a dental office more often than they are seen by the physician or a nurse for medical care.29,30 Someone who has pain related to a tooth or oral lesions will select a dental office to solve this problem usually being treated and then released. Dental treatment for mouth pain will usually be sanctioned by the perpetrator because the victim is taken out of service, thereby, causing them to lose money.15,18,21 The perpetrator will agree to treatment so the victim can return to current work-related activities.
Medical institutions are suggesting that more training be made available to all those who interact with patients. This would include employees in dental schools, dental offices, emergency rooms, hospitals, airline employees and other transportation facilities. Local and state resources available for reporting suspicious activity should be made available to those involved in working with the public.16,21,36 If the victim of trafficking is identified but resources and a protocol (trauma-informed approach) are not in place, the victim may be in even more danger during this process. The person may be beaten (or worse) if the perpetrator believes the victim has identified them or made their situation known to healthcare providers.1,6,16,18
Although healthcare providers are an essential component in the detection of human trafficking, most healthcare providers have very little knowledge or experience in the detection of these individuals who are victims. They know little about identifying victims and perpetrators or how to respond to situations, even if they do suspect the patient to be a victim.9-11 Recently, more publications and guidance on the subject is emerging. However, there is a continued need to educate and provide direction in the medical and dental curriculum to those healthcare providers in order to recognize the signs of trafficking. Healthcare professionals need to be confident in reporting suspected cases of child abuse and human trafficking.2,6,8,9,20 The saying, “The eye doesn’t see what the mind does not know” is very appropriate in the case of human trafficking. The Reclaim 611 organization suggests that a “trauma-informed” approach be implemented in healthcare facilities. Basically, everyone should know the correct protocol and a specific sequence should be implemented if or when the occasion arises.31,32
Most healthcare providers, especially the dental community, do not know the extent of the human trafficking problem in the United States, nor the global impact of this crime.2,9 Up to 87.7% of trafficking victims obtain some form of healthcare treatment during captivity, but they are not usually recognized as a trafficking victim by those who treat them.10,11,21 Only 24% of healthcare providers reported confidence in their ability to identify an at-risk child.27 In order to report child abuse, only a reasonable suspicion is needed and privileged communication does not apply in cases of child abuse. The Child Welfare Information Gateway lets you search State Guides and Manuals.25 Unless there is concrete evidence of physical abuse, specific clues may be overlooked. Even if suspected, the proper protocol for handling any suspicion may not be known by most in dentistry.
At the time of this course, education in trafficking varies globally. In the United States, most dental schools and dental hygiene schools do not have curriculum in place to train dentists, hygienists or office staff in recognizing the possibility of a patient being a human trafficking victim. Most locations in the UK have trafficking information in the form of workbook education, face-to-face learning, E-learning and lecture.11
Child abuse is usually covered in dental schools with mandated reporting of suspected cases; however, human trafficking is an area that is still very vague to the dental community. Although some physical abuse may be present with trafficking victims, the signs are far more subtle. Since the perpetrator may accompany the victim to an appointment, there is equal opportunity to assess the relationship of the perpetrator and the victim by all involved in treatment of the patient. In a trauma-informed approach, this would include the dentist, hygienist, dental assistant, office manager and any other personnel working in the office, clinic or facility such as a college or university. One individual may assess the situation and other personnel may be in tune with various clues as the office visit progresses. Therefore, utilizing and training the entire office is the most beneficial approach.
In a trauma-informed approach, all staff of a facility know who to call, how to talk to the patient in order to promote a calm, directed interaction that will lead to successful and safe rescue of the victim or apprehension of the perpetrator. In some cases, the adult victim may decline assistance, but with a trauma-informed office, hospital, clinic or staff, the end result would be much safer when knowledge of protocol exists. If the perpetrator feels threatened, the victim may be at more increased risk as well as those within the dental office.