RxCe - Human Trafficking Materials

HUMAN TRAFFICKING

ALLISON MOON, DNP, PMHNP-BC

Allison Moon works as a Doctor of Nursing Practice, Psychiatric Mental Health Nurse Practitioner, and Lieutenant Commander in the United States Navy Reserves (USNR). She collaborates with a multidisciplinary team to help children, adolescents, and their families in Montana in an inpatient unit at a psychiatric hospital. She has had the honor of treating sailors across the United States and the world serving in the USNR. She completed her Bachelor of Science in Nursing in 2009 and Master’s in Nursing in 2013 at Montana State University in Bozeman, MT. She obtained her Doctor of Nursing Practice from the University of North Dakota in 2016. She is passionate about collaborating with patients facing psychiatric challenges to help, heal and inspire hope.

Topic Overview

Human trafficking is considered a form of modern slavery, and it is global in its reach and impact. Trafficking in persons affects all genders, ages, and ethnicities. Human trafficking is not found only within illegal businesses. Human trafficking can be found in a wide variety of otherwise legal businesses, industries, and services, including many economic sectors in the United States. They include agriculture, food service, sales, domestic services, construction and landscaping, commercial sex, and marriage. Human trafficking adversely affects a victim’s mental and physical stability, security, and well-being. It adversely affects entire communities, commerce, countries, and geographical regions. Pharmacists are uniquely situated to identify victims of human trafficking through patient contact. Pharmacists need to know when and how to report human trafficking and the resources that are available to support victims who have been trafficked.

Accreditation Statement:

RxCe.com LLC is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education.

Universal Activity Number (UAN): The ACPE Universal Activity Number assigned to this activity is

Pharmacist 0669-0000-22-033-H99-P

Pharmacy Technician 0669-0000-22-034-H99-T

Credits: 1 hour of continuing education credit

Type of Activity: Knowledge

Media: Internet Fee Information: $4.99

Estimated time to complete activity: 1 hour, including Course Test and course evaluation

Release Date: September 6, 2022 Expiration Date: September 6, 2025

Target Audience: This educational activity is for pharmacists.

How to Earn Credit: From September 6, 2022, through September 6, 2025, participants must:

Read the “learning objectives” and “author and planning team disclosures;”

Study the section entitled “educational activity;” and

Complete the Post-test and Evaluation form. The Post-test will be graded automatically. Following successful completion of the Post-test with a score of 70% or higher, a statement of participation will be made available immediately. (No partial credit will be given.)

Learning Objectives: Upon completion of this educational activity, participants should be able to:

Describe the types and venues of human trafficking in the United States.

Identify victims of human trafficking and the role of pharmacists in identifying potential victims of human trafficking.

Identify strategies for identifying, preventing, and increasing awareness of human trafficking in healthcare settings.

Describe how to report known or suspected cases of human trafficking

Disclosures

The following individuals were involved in the development of this activity: Allison Moon, DNP, PMHNP-BC, Susan DePasquale, MSN, PMHNP-BC, Amanda Mayer, PharmD, and Jeff Goldberg, PharmD. There are no financial relationships relevant to this activity to report or disclose by any of the individuals involved in the development of this activity.

Introduction

Human trafficking is considered a form of modern slavery, and it is global in its reach and impact. Human trafficking more often involves the sexual exploitation of persons and forced labor but other forms of trafficking in persons are also perpetrated. Human trafficking adversely affects a victim’s mental and physical stability, security, and well-being. It adversely affects entire communities, commerce, countries, and geographical regions. Pharmacists are uniquely situated to identify victims of human trafficking through patient contact. Federal law focuses on criminal law and the prosecution of human trafficking. While federal law encourages states to enact mandatory reporting of human trafficking in certain cases, state laws vary. This means there is not a single, nationwide set of laws that govern reporting of suspected human trafficking. Pharmacists need to know when and how to report human trafficking and the resources that are available to support victims who have been trafficked. This requires a pharmacist to know federal law and the laws of the state where the pharmacist is licensed.

Defining the Scope of Human Trafficking

Human trafficking or trafficking in persons (TIP) is a crime, and a violation of a person’s human rights.1,2 These serious crimes are global, affecting every nation, including the United States.1,2 Human trafficking involves the exploitation of a person against the person’s will. The victim may be recruited, transported, harbored, transferred, or received for exploitation. This may be accomplished through force, abduction, fraud, or coercion. Exploitation can take the form of forced labor, sexual acts, military involvement, or the harvesting of organs.3

Human trafficking is often considered in its narrow scope as a criminal justice matter but it is also a serious healthcare issue.3 Victims may seek healthcare services to address the negative health effects associated with human trafficking. This means that healthcare professionals may encounter victims of human trafficking when they are providing medical services.3

Trafficking in persons affects all genders, ages, and ethnicities. Women, including women who are forced into prostitution, children, and men are all victims of human trafficking. It is often associated with organized crime, but human trafficking can be more localized and include perpetrators who are family, friends, neighbors, or employers operating legal businesses. Human trafficking can be found in a wide variety of otherwise legal businesses, industries, and services.3 Koegler, et al. (2019) described some of the economic sectors in the United States where trafficking occurs. They include agriculture, food service, sales, domestic services, construction and landscaping, commercial sex, and marriage.4

Prevalence of Human Trafficking Worldwide

Reliable figures of the prevalence of human trafficking are difficult to calculate because of the mostly illegal, hidden nature of these crimes.4 There are an estimated 40 million people globally who are victims of human trafficking.4 Human trafficking grosses an estimated $150 billion annually worldwide.4

Human Trafficking in the U.S.

In the U.S., TIP is most likely to fall under the categories of sex trafficking (sometimes referred to as commercial sexual exploitation), and labor trafficking.4 The United States responded to the problem of human trafficking through the Trafficking Victims Protection Act (TVPA), passed by the United States Congress in the year 2000.5 The Act has been amended as recently as 2021.5 The TVPA attempts to confront TIP globally.4,5 The most common forms of TIP appear to be sex trafficking, labor or forced labor trafficking, and child soldiering.6 Sex trafficking and forced labor were part of the original legislation in 2000.5 Protection for child soldiers was added in the Trafficking Victims Protection Reauthorization Act of 2008.7

Under the TVPA, sex and labor trafficking are broadly defined to include a myriad of acts of fraud, force, or coercion. For example, sex trafficking includes “all the elements of the crime of forcible rape when it involves the

involuntary participation of another person in sex acts by means of fraud, force, or coercion, [and it] also involves violations of other laws, including labor and immigration codes and laws against kidnapping, slavery, false imprisonment, assault, battery, pandering, fraud, and extortion.”8

Under the TVPA, sex trafficking is defined as “the recruitment, harboring, transportation, provision, obtaining, patronizing, or soliciting of a person for the purpose of a commercial sex act.”11 Sex trafficking is also described as a severe form of trafficking in persons. This involves “a commercial sex act” that is “induced by force, fraud, or coercion, or in which a person induced to perform such act has not attained 18 years of age….”9 The term “commercial sex act” means any sex act on account of which anything of value is given to or received by any person.10

Severe forms of TIP also include labor trafficking.11 This involves the “recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, using force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery.”11

The TVPA defines debt bondage and involuntary servitude in the context of human trafficking. Debt bondage is described as a pledge of personal services by a debtor, or a person controlled by the debtor, as a security for a debt to another, where the “value of the debtor’s services as reasonably assessed is not applied toward the liquidation of the debt or the length and nature of those services are not respectively limited and defined.”12 Involuntary servitude is defined as servitude induced by “any scheme, plan, or pattern intended to cause a person to believe that, if the person did not enter into or continue in such condition, that person or another person would suffer serious harm or physical restraint [or by] abuse or threatened abuse of the legal process.”13

It is important to note that these definitions indicate that human trafficking does not necessarily mean moving or smuggling a person or holding a person in captivity. Human trafficking is the dealing or sale of humans as a commodity for profit. It is viewed by some as modern slavery, with the victim

being held in bondage and exploited for financial gain.14,15 There is also an overlap between the concepts of sex and labor trafficking since a “sex employee” may be subjected to both.4

With the broad presence of TIP and the overlap of categories, a significant number of federal agencies are involved in the investigation and prosecution of TIP. According to the U.S. Department of State Trafficking in Person Report, 20th Edition, in 2019, the Department of Homeland Security, the Department of Justice, and the Department of Defense are each involved in investigating cases of human trafficking.1 The trends and numbers of investigations, prosecutions, and convictions of human traffickers are also set forth in the Trafficking in Person Report, 20th Edition.1 The focus here is on prosecuting human trafficking after the fact. While this helps control human trafficking, it does not provide the prevention that could be implemented to stop human trafficking before it happens.

Risk Factors for Sex/Labor Trafficking in the U.S.

There are specific risk factors for sex trafficking in the U.S. Individuals who are most at-risk include the following persons: 1) female gender;

2) children between the ages of 12 and 14; 3) a person in an abusive relationship; 4) a person suffering from a drug addiction; 5) a runaway or homeless person; 6) a person who is a low educational achiever; 7) a person who is in state foster care; 8) a person who is in the juvenile correction system; and, 9) a member of the LGTBQ community.14

Risk factors for labor trafficking are similar to sex trafficking, except that reports of labor trafficking indicate male gender is a greater risk factor.4 In addition, other factors include “an international airport, interstate highway connections, sporting centers, multiple strip clubs, high poverty, violence, widespread substance use, a weak education system, high numbers of homeless and runaway children, and large immigrant populations.”4

It is generally believed that women are at a greater risk of human trafficking because they make up the larger part of sex trafficking, and they are also at risk of being subject to forced labor; however, Koegler, et al., point out that this greater risk may be perceived but not a real difference. It may be due instead to reporting, awareness, and available services for female versus male victims but these statistics are unknown.4

Reid, et al. (2017) evaluated 913 juvenile justice cases in Florida.16 The purpose of the study was to see the role adverse childhood experiences played as a risk factor for victimization in human trafficking. Among the boys and girls in the study, the authors found that sexual abuse was the most damaging childhood adversity. This adverse event was linked to victimization in human trafficking, and it appeared to make boys and girls more susceptible to exploitation.16 The authors’ findings were consistent with other research on this issue, which found “that although cumulative trauma is more harmful than singular instances of trauma, sexual abuse may be a particularly strong form of childhood trauma that functions as a ‘gateway’ trauma initiating increased exposure to other forms of victimization.”16

Consequences of Human Trafficking

Trafficked individuals experience many adverse physical health issues.14,15 Negative impacts on a victim’s psychological and emotional state are also a consequence of human trafficking.14,15 The abuse may even lead to trauma bonding by the victim.1 The reality is that many of the physical and emotional scars from human trafficking remain with the victim long after the trafficking ends.14

Physical Consequences

Victims of human trafficking are often subjected to physical abuse by the perpetrator. The victim may be beaten, burned, or raped.14 A victim may be forced to take drugs, with the intent being that the victim will become dependent on the perpetrator.14 Some traffickers engage in what is called tattooing, which is a way to “brand” the victim.14

Injuries a victim may suffer from physical assaults include chronic pain and fatigue, poor nutrition, disability, and chronic and acute injuries to the body or organs.14 Sexual assaults may result in sexually transmitted diseases, pubic lice, or human immunodeficiency virus and AIDS.14 Women may experience urinary tract infections, changes in their menstrual cycle, acute or chronic pain during sex, vaginal injuries, anal injuries, unwanted pregnancies, cervical dysplasia, or cancer.14,15

Psychological Consequences

The victim of human trafficking is often threatened, humiliated, and forced to misuse drugs.14 These psychological traumas are done with the goal of controlling and manipulating the victim.14 In many instances, these traumas are compounded upon childhood experiences of the victim, such as abandonment, poverty, and physical and sexual abuse.14 These psychological traumas may lead to mental disorders, e.g., anxiety, depression, suicide, self- harm, and post-traumatic stress disorder.14,15

Substance Misuse or Dependence

Substance misuse or dependence is frequently seen among victims of human trafficking.14,15 This could lead to substance overdose, complications from substance use, and dual diagnosis of mental illness and substance misuse.14,15

Human Trafficking and Trauma Bonding

A hostage of a human trafficker, or a victim of exploitation by a human trafficker, may develop a bond or affection for his or her captor or perpetrator.17-19 This paradoxical, psychological phenomenon is referred to as trauma bonding.17-19 Although trauma bonding may be more likely when a victim is imprisoned for a meaningful time, it may arise in situations where a person’s physical freedom is limited but not fully taken away, such as with some victims of sexual exploitation.18,19

Scholars have defined trauma bonding and described the conditions that give rise to it but because of the complexities of this psychological phenomenon, there is no consensus on trauma bonding’s causes, preconditions, or diagnostic criteria.17 Nevertheless, there are general statements that may be made when describing trauma bonding. Trauma bonding is an “emotional attachment” between a victim and the trafficker or captor.18 This attachment or bond with the perpetrator is paradoxical since the perpetrator is abusive and controlling, and usually creates an environment where the victim is wholly dependent on the offender.18 In response to this abuse, the victim develops “deep feelings of love, admiration, and gratitude” toward the abuser.18 These responses are similar to a theory known as Stockholm Syndrome.17 Because of this similarity, the term trauma bonding has been used synonymously with Stockholm Syndrome.

Underlying Stockholm Syndrome is the idea that a hostage or victim of exploitation may develop a bond with the captor to help the victim survive captivity.19 Stockholm Syndrome is considered an effect of captivity; however, it may also be viewed as a response to captivity, a way of coping or surviving an “extreme and life-threatening” circumstance.20 The term was introduced by criminologist Nils Bejerot. In Sweden, in 1973, armed men entered a bank with the intention to rob it. During the robbery, the assailants took hostages. Nils Bejerot analyzed the actions of the hostages toward their captors during the standoff.20 The hostages were placed in an extreme, life-threatening experience but they developed positive feelings toward their captors. These positive feelings continued after their captivity ended and the bank robbers were captured. In fact, unbelievably, the hostages even helped pay for their captors’ criminal defense for attempted bank robbery and false imprisonment.20

Stockholm Syndrome is not a recognized or accepted medical or psychiatric syndrome. Its lack of acceptance may be due to its rarity and lack of research and studies in a scientific setting that can produce meaningful evaluations.17,18,20 Karan, et al. (2018) described four preconditions that together can give rise to Stockholm Syndrome. The first precondition is a perceived mortal or serious threat the victim believes the captor will carry out.

Secondly, the captor will express love or kindness to the victim. Thirdly, the victim must be isolated from the outside world. Finally, the victim believes there is no reasonable way of escape. From these four preconditions, the victim develops love, affection, or positive feelings toward the victim’s captors, as a psychological way to survive in captivity.19 Often, it is the more vulnerable populations who are more susceptible to Stockholm Syndrome.21

Bonding is not always unilateral. There are cases where positive feelings are reciprocal between the captor and victim. This is in contrast with the situation where the captor’s apparent affection is not genuine but is calculated to cultivate the victim for profit.18 These complexities make this area of research ripe for further investigation. Analysis of this phenomenon has been limited mostly to the United States, and the focus of this research has been almost exclusively related to the sex trafficking of women and girls.17 According to the U.S. State Department, greater research is needed to understand trauma bonding and the role it may play in the lives of persons who are or have been trafficked.17

Identifying the Victims of Human Trafficking

According to studies, up to 88% of persons who are victims of human trafficking see a healthcare provider.3,22 This means that healthcare professionals, including pharmacists, are uniquely situated to identify and assist trafficked individuals and to report trafficking to the proper authorities.22,23 Successfully identifying victims is partly dependent on whether the provider has received training to identify them. For example, pharmacists who receive training to help them identify human trafficking identifying victims will do better, and they are more likely to report the crime.23 Pharmacists are particularly accessible to patients, and they can play an important role in identifying victims and guiding them to safety.23

Identifying victims of human trafficking begins with an understanding of characteristics that are found with human trafficking.3 Healthcare providers are frequently blinded to human trafficking because of common misconceptions. Many providers do not believe that human trafficking can or

does occur in their town or city in the U.S.23 They also view victims as female, sex workers. While female, sex workers are subjected to human trafficking, men and boys may be victims as well. Moreover, labor trafficking is widespread and reaches well beyond the sex industry.23 Healthcare providers must remind themselves that while many victims of human trafficking are girls and women, victims can also include boys, men, or older adults. They may be citizens of the country or foreign nationals who are in the U.S., legally, or who are undocumented.4

Regardless of gender, age, or background, the victims of human trafficking are part of a vulnerable group within society.14 Factors that make a person vulnerable are seen in almost every risk factor associated with human trafficking. They include the following:4,14,21

Victims with a history of childhood sexual abuse

Runaways, juvenile delinquency, Child Protective Services involvement

Transgender individuals

Homeless youth (who can easily become coerced or forced into a human trafficking situation)

Foreign nationals (who are far away from home, may not speak the language, have no support systems, and may be in the country illegally)

People who come from politically unstable countries or countries in which there is war or widespread violence (who may be desperate to leave and can easily be exploited)

Anyone who is poor or comes from a country in which there is significant economic instability

People who have disabilities

Victims of domestic violence and/or sexual abuse

Patients that have any of the above risk factors may be victims of human trafficking.

Screening Tools for Victims of Human Trafficking

Not enough is known about whether assessment tools to screen for victims of human trafficking are effective or sensitive to either sexual or labor exploitation. Not all the tools raised in the health and social welfare literature are discussed in full detail here; however, several tools show promise for identifying risk factors associated with human trafficking in various geographic regions.22-26 Some of these tools provide multi-lingual applications. Greenbaum (2016) developed questions to be used for screening victims of human trafficking in the emergency department setting.24 Greenbaum (2018) provides an evaluation tool to identify children who are victims of sex trafficking.25 Chisolm-Straker, et al. (2019) recommend screening tools for human trafficking among homeless young adults.26 Tiller and Reynolds (2020) adapted Greenbaum’s questionnaire and other tools and produced a questionnaire that focuses on sex and labor trafficking.22 This questionnaire is currently available for open access on PubMed.22

Rosenthal (2019) provides pharmacist-specific questions to identify victims of trafficking: “Where do you store your medications? How do you keep track of your medications? Who is in charge of handling your medications? What are you taking this medication for? How did your provider tell you to take these medications?”23

There is a significant social stigma for human trafficking victims who attempt to access health and social services. Pharmacists need to be able to identify victims and connect them safely and appropriately with services that provide a haven and rehabilitation. Factors that can guide clinicians in the use of a proper psychosocial assessment tool include the following:23-26

An injury or illness that cannot be explained.

An explanation cannot logically or factually account for the injury/illness.

Medical care is sought long after it seems reasonable to have done so.

Some injuries suggest intentional harm, such as bruises on the face or around the neck, intentional burn marks, puncture wounds, or trauma to the genitals.

Someone who seeks medical attention is accompanied by a friend who insists on always being with that person is very controlling, and answers for the individual who is injured or sick. The injured or sick party seems hesitant and fearful when the ‘friend’ is nearby.

The same person is seen multiple times for the same illnesses or injuries. Examination of their records may show no voluntary follow-up care for these problems and/or no compliance with recommended treatments – both of which require time and money, neither of which the victim possesses.

The patient is exceptionally fearful and nervous while being questioned and examined.

The complaints always involve injuries, issues surrounding drug use, or are related to sexual activity.

The patient’s complaint seems memorized or scripted.

The patient has no identification.

Providers should also screen patients suspected of being victims of human trafficking “for feelings of helplessness, shame, humiliation, distrust, self-hatred, disbelief, denial, suicidal thoughts, disorientation, confusion, and phobias.”15

If human trafficking is suspected, a focused private interview should be the next step. The questions should be nonjudgmental, open-ended, and framed in a way that encourages the patient to talk.23-26 Interviewers of human trafficking victims found that the victims were more likely to be open and candid if the healthcare professional appeared to be knowledgeable about trafficking, was respectful, and showed a nonjudgmental attitude.23-26

Reporting Human Trafficking

There is currently not a nationwide, single rule on mandatory reporting for human trafficking. Federal law is more focused on making human trafficking illegal and then prosecuting those who violate the law.1,2 This leaves most of the requirements of mandatory reporting of human trafficking to the states. Federal law encourages states to enact reporting laws for trafficking

through federal funding for such programs.27 State laws vary greatly.27-30 Some states have requirements for reporting sex trafficking, and other states have laws for reporting labor trafficking.28 In cases of suspected human trafficking of a competent adult who is not elderly, some states may require patient consent before a report can be made.27,29 In situations that clearly fall under mandatory reporting, pharmacists should not hesitate to make a report. In other situations, efforts should be made to secure patient consent to disclose information to authorities.

These differences in state laws make it imperative for a pharmacist to be familiar with the mandatory reporting laws of the pharmacist’s state. Once a pharmacist has clarity on the applicable state laws, there will be greater certainty on when to report suspected human trafficking. For example, certain consequences of human trafficking like gunshot wounds, stab wounds, child abuse, intimate partner violence, elder abuse, and sexual assault are likely covered by mandatory reporting laws in the pharmacist’s state, and these situations should be reported to the appropriate authority.27

Reports of human trafficking may be made to the National Human Trafficking Resource Center (NHTRC). The NHTRC operates a National Human Trafficking Hotline that is available every day, 24 hours, at 1-888-373-7888, and SMS: 233733 (Text “HELP” or “INFO”). The National Human Trafficking Hotline can provide information, guidance, and resources for pharmacists who have questions about human trafficking.30

Some states, for example, Texas, have hotlines set up to report human trafficking. Texas has an iWatchTexas hotline at 844-643-2251, or a person may report human trafficking online at https://iwatchtx.org/index.html. 31 National and state hotlines can be particularly useful in cases where a pharmacist suspects human trafficking or is uncertain as to whether suspected cases of human trafficking can be reported without patient consent. Pharmacists should consult their state laws for human trafficking reporting and further guidance on what to do when they suspect human trafficking.

Interdisciplinary Health Team Role in Reporting and Referral

All members of the health team have a role to play in identifying and intervening to help victims of human trafficking. Human trafficking has become a significant public health burden. Various health sites, including pharmacies, may unknowingly treat victims of human trafficking who have suffered physical injuries and who have mental health illnesses.23,32 A greater percentage of victims of human trafficking are helped and provided resources when healthcare professionals receive proper education and training on screening and reporting.

Resources for Victims of Human Trafficking

Pharmacists can direct human trafficking victims to available resources. One such resource is the National Human Trafficking Hotline. The laws of some states provide specific rights for the victims of crimes.33 These victims necessarily include victims of human trafficking. Pharmacists should consult their state laws and resources so that they are aware of the rights of victims, and the resources available in their state for victims of human trafficking. This information may then be made available to victims identified in the pharmacy setting.

Summary

Human trafficking is a crime and a violation of a person’s human rights. These serious crimes are global, affecting every nation, including the United States. Human trafficking involves the exploitation of a person against their will. The victim may be recruited, transported, harbored, transferred, or received for exploitation. This may be accomplished through force, abduction, fraud, or coercion. Exploitation can take the form of forced labor, sexual acts, military involvement, or the harvesting of organs.

In the U.S., human trafficking is most likely to fall under the categories of sex trafficking and labor trafficking. Under the TVPA, sex and labor trafficking are broadly defined to include a myriad of acts of fraud, force, or

coercion. The TVPA defines sex trafficking as a commercial sex act that is “induced by force, fraud, or coercion, or in which a person induced to perform such act has not attained 18 years of age….” The term “commercial sex act” means any sex act on account of which anything of value is given to or received by any person. Labor trafficking involves the “recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, using force, fraud, or coercion for subjection to involuntary servitude, peonage, debt bondage, or slavery.”

There are specific risk factors for sex trafficking in the U.S. Individuals who are most at-risk include the following persons: 1) female gender;

Trafficked individuals experience many adverse physical health issues. Negative impacts on a victim’s psychological and emotional state are also a consequence of human trafficking. The abuse may even lead to trauma bonding by the victim. The reality is that many of the physical and emotional scars from human trafficking remain with the victim long after the trafficking ends.

Pharmacists are uniquely situated to identify and provide assistance to trafficked individuals and to report trafficking to the proper authorities. There are differences in state laws regarding mandatory reporting of suspected human trafficking. This makes it imperative for a pharmacist to be familiar with the mandatory reporting laws of the pharmacist’s state.

References

U.S. Department of State. Trafficking In Person Report: 20th Ed. June 2020. Retrieved at https://www.state.gov/wp- content/uploads/2020/06/2020-TIP-Report-Complete-062420- FINAL.pdf

United Nations. PROTOCOL TO PREVENT, SUPPRESS AND PUNISH TRAFFICKING IN PERSONS, ESPECIALLY WOMEN AND CHILDREN, SUPPLEMENTING THE UNITED NATIONS CONVENTION AGAINST TRANSNATIONAL ORGANIZED CRIME. 2000. Retrieved from

https://www.osce.org/odihr/19223?download=true

Lee H, Geynisman-Tan J, Hofer S, Anderson E, Caravan S, Titchen K. The Impact of Human Trafficking Training on Healthcare Professionals' Knowledge and Attitudes. J Med Educ Curric Dev. 2021;8:23821205211016523. Published 2021 May 17. doi:10.1177/23821205211016523

Koegler E, Mohl A, Preble K, Teti M. Reports and Victims of Sex and Labor Trafficking in a Major Midwest Metropolitan Area, 2008-2017. Public Health Rep. 2019;134(4):432-440. doi:10.1177/0033354919854479

22 USC §§ 7101, et seq.

Department of Defense. Combating Trafficking in Persons Program. Trafficking in Persons. Retrieved at 101https://ctip.defense.gov/Portals/12/Trafficking_in_Persons_101_Fac t_Sheet_2020.pdf?ver=2020-08-20-143340-510

The William Wilberforce Trafficking Victims Protection Reauthorization Act of 2008. 110 P.L. 457, 122 Stat. 5044.

22 U.S.C. §§ 7101 (9) and (10)

22 U.S.C. § 7102 (11)(A)

22 U.S.C. § 7102 (4)

22 U.S.C. § 7102 (11)(B)

22 U.S.C. § 7102 (7)

22 U.S.C. § 7102 (8)

Richie-Zavaleta AC, Villanueva A, Martinez-Donate A, Turchi RM, Ataiants J, Rhodes SM. Sex Trafficking Victims at Their Junction with the Healthcare Setting-A Mixed-Methods Inquiry. J Hum Traffick. 2020;6(1):1-29. doi:10.1080/23322705.2018.1501257

Deshpande NA, Nour NM. Sex trafficking of women and girls. Rev Obstet Gynecol. 2013;6(1):e22-e27.

Reid JA, Baglivio MT, Piquero AR, Greenwald MA, Epps N. Human Trafficking of Minors and Childhood Adversity in Florida. Am J Public Health. 2017;107(2):306-311. doi:10.2105/AJPH.2016.303564

OFFICE TO MONITOR AND COMBAT TRAFFICKING IN PERSONS. TRAUMA BONDING IN HUMAN TRAFFICKING. June 2020.

https://www.state.gov/wp-content/uploads/2020/10/TIP_Factsheet- Trauma-Bonding-in-Human-Trafficking-508.pdf. Accessed August 22, 2022.

Casassa K, Knight L, Mengo C. Trauma Bonding Perspectives From Service Providers and Survivors of Sex Trafficking: A Scoping Review. Trauma Violence Abuse. 2022 Jul;23(3):969-984. doi: 10.1177/1524838020985542. Epub 2021 Jan 18. PMID: 33455528.

Karan A, Hansen N. Does the Stockholm Syndrome affect female sex workers? The case for a "Sonagachi Syndrome." BMC Int Health Hum Rights. 2018;18(1):10. Published 2018 Feb 6. doi:10.1186/s12914-

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Alexander DA, Klein S. Kidnapping and hostage-taking: a review of effects, coping and resilience. J R Soc Med. 2009;102(1):16-21. doi:10.1258/jrsm.2008.080347

Panlilio CC, Miyamoto S, Font SA, Schreier HMC. Assessing risk of commercial sexual exploitation among children involved in the child welfare system. Child Abuse Negl. 2019 Jan;87:88-99. doi: 10.1016/j.chiabu.2018.07.021. Epub 2018 Aug 1. PMID: 30077402; PMCID: PMC8996260.

Tiller J, Reynolds S. Human Trafficking in the Emergency Department: Improving Our Response to a Vulnerable Population. West J Emerg Med. 2020;21(3):549-554. Published 2020 Apr 16.

doi:10.5811/westjem.2020.1.41690

Rosenthal M. Human Trafficking: Hiding in Plain Sight. Pharm Pract News. Policy Section. 2019; Sept. 10, online issue. Retrieved at https://www.pharmacypracticenews.com/Policy/Article/0616/Human- Trafficking-Hiding-in-Plain-Sight/55806

Greenbaum J. Identifying Victims of Human Trafficking in the Emergency Department. Clinical Pediatric Emergency Medicine. 2016; Vol 17, Issue 4; Pages 241-248

Greenbaum J. Evaluation of a Tool to Identify Child Sex Trafficking Victims in Multiple Healthcare Settings. Journal of Adolescent Health. 2018; Vol. 63; Issue 6: 745-752.

Chisolm-Straker M, Einbond J, White J, Stoklosa H. Screening for human trafficking among homeless young adults. Children and Youth Services Review. 2019; Vol 98: Pages 72-79.

English A. Mandatory Reporting of Human Trafficking: Potential Benefits and Risks of Harm. AMA J Ethics. 2017;19(1):54-62. doi: 10.1001/journalofethics.2017.19.1.pfor1-1701

Atkinson HG, Curnin KJ, Hanson NC. US state laws addressing human trafficking: education of and mandatory reporting by health care providers and other professionals. J Hum Trafficking. 2016; 2(2):111- 138.

Powell C, Asbill M, Brew S, Stoklosa H. Human Trafficking and HIPAA: What the Health Care Professional Needs to Know. J. Hum. Traffick. 2018; 4(2): 105-113.

National Human Trafficking Hotline. https://humantraffickinghotline.org

Attorney General of Texas. Human Trafficking Section. Human Trafficking in Texas. https://www.texasattorneygeneral.gov/human- trafficking-section. Accessed September 9, 2022.

Palombi LC, Van Ochten H, Patz C. The Pharmacists’ Role in Identifying and Supporting Victims of Human Trafficking. Journal of Human Trafficking. 2019; 5:3, 255-266, doi:10.1080/23322705.2018.1494486

Article I § 24, Const. of Mich. of 1963.

DISCLAIMER

The information provided in this course is general in nature and it is solely designed to provide participants with continuing education credit(s). This course and materials are not meant to substitute for the independent, professional judgment of any participant regarding that participant’s professional practice, including but not limited to patient assessment, diagnosis, treatment and/or health management. Medical and pharmacy practices, rules, and laws vary from state to state, and this course does not cover the laws of each state; therefore, participants must consult the laws of their state as they relate to their professional practice.

Healthcare professionals, including pharmacists and pharmacy technicians, must consult with their employer, healthcare facility, hospital, or other organization, for guidelines, protocols, and procedures they are to follow. The information provided in this course does not replace those guidelines, protocols, and procedures but is for academic purposes only, and this course’s limited purpose is for the completion of continuing education credits.

Participants are advised and acknowledge that information related to medications, their administration, dosing, contraindications, adverse reactions, interactions, warnings, precautions, or accepted uses are constantly changing, and any person taking this course understands that such person must make an independent review of medication information prior to any patient assessment, diagnosis, treatment and/or health management. Any discussion of off-label use of any medication, device, or procedure is informational only and such uses are not endorsed hereby.

Nothing contained in this course represents the opinions, views, judgments, or conclusions of RxCe.com LLC. RxCe.com LLC is not liable or responsible to any person for any inaccuracy, error, or omission with respect to this course, or course material.

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