Exhi1.30 Case Document Filed Page of Case Document Filed Page of PM Human Trafficking Red Flags for Dental Professionals Decisions in Dentistry Decisions Course Library New User Existing User Help Misc llan ous Latest CE Cours Human Trafficking Red Flags for Dental Professionals Dentists and dental hygienists should look for the subtle signs of victimization so they can offer appropriate treatment resources and referrals By Sheryl Syme RDH MS Susan Camardese RDH MS and Kimberly Mehlman-Orozco PhD On Aug Dentists and dental hygienists should look for the subtle signs of victimization so they can offer appropriate treatment resources and referrals PURCHASE COURSE This course was published in the August issue and expires August The authors have no commercial conflicts of interest to disclose This credit hour self-study activity is electronically mediated OBJECTIVES After reading this course the participant should be able to Discuss trends in human trafficking and oral health professionals role in identifying treating and helping victims Explain the types of individuals that human traffickers target and tactics for manipulating victims Describe common oral injuries that trafficking victims present with as well as reasons why victims typically underreport abuse This website uses cookies to improve your experience Well assume youre ok with this but you can opt-out if you wish Accept Read More https ofessionalsl Case Document Filed Page of PM Human Trafficking Red Flags for Dental Professionals Decisions in Dentistry Human trafficking is a rampant global health problem affecting a growing number of childre r14Gdf JO kla61 Idwide basis traffickers use fraud coercion threats and deception to manipulate victims into various forms of exploitation including domestic servitude sex trafficking sham marriages forced labor and criminal activity Trafficking is identified as a form of slavery and a major yet often hidden crime involving the control of victims for the traffickers economic gain Targeting potential victims who appear lost disenfranchised or in desperate situations traffickers are adept at isolating victims from social support systems and creating dependency limiting victims movement to work settings and hiding the red flags and signs of victimization Victims are often lured by promises of lucrative employment stability ability to obtain an education a steady income to send home to support their families or a loving relationship some or all of which represent opportunities absent in the victims life While the stories of trafficked survivors often include accounts of trying to improve their lives or that of their families and desires to migrate to areas that promise a better future these individuals are not always migrants Although transportation may be a control tactic to keep human trafficking victims in unfamiliar places the defining characteristic is exploitation for profit rather than being moved from one region to another Given the extent of the problem and fact that trafficked individuals may seek dental treatment oral health professionals have a responsibility to recognize the signs that may indicate victimization and be prepared to provide appropriate treatment resources and referrals Table The United States is a key source site of transport and destination for trafficked individuals Reports of trafficking to the National Human Trafficking Hotline and Polaris BeFree Textline have been increasing in all SO states and Washington The National Human Trafficking Hotline is partially funded by the Department of Health and Human Services and is operated by Polaris a nonprofit nongovernmental anti-trafficking organization While a lack of uniformity in reporting and tracking victims in a universal database as well as the clandestine nature of this criminal activity creates challenges in identifying victims the U.S Department of State estimates more than million individuals are subjected to human trafficking worldwide As regional and global markets increase for human trafficking so too does the need to identify trafficked individuals Considering that health care providers may be among the few professionals to come in contact with these individuals it behooves clinicians to be prepared to identify possible victims BL sourc for ee i ng el or port i ng Hum a ra ffic i ng Resources Purpose National Human Trafficking Hotline Local Police Depart ent or ocal contact number Department of Homeland Security Blue Campaign to fnd Human Trafficking dhs.govlblue-campaignlvictim entered Polar i ect webs i te and Resource Center pofarisproject org Immigration and Customs Enforcement ICE Homeland Security Investigations HS I or repc rt online using the HSI Tip Form ice.govlwebform!his-tip-form TRAFFICKING Case Document Filed Page of PM Human Trafficking Red Flags for Dental Professionals Decisions in Dentistry LE Human Traffick i ng Assessm nt Qu stions Clinicians should identify their interest in helping and avoid sounding judgmental when asking the following screening questions Are you living and work i ng in a safe place Where and when do you sleep Have you ever been pressured to do something lhat you didnt wont to do were uncomfortable doing Have you eVl!r been threatened or i ntimated by S"Omeone II ro what did this person say would happen to yoo Are you able to come and go freely at home and work What happens if you e;ive or talk of leaving home or work Do you access to any money orthe money you earn Has anyone t.iken some or all of your money herd your money with promi kee it safe Do you owe money to someone Ate you in debt to someone and hO are you paying off the debt Does someone control supei ise and/or monitor you and you work Has your communiC11tion with others been restricted or cut off Have you E!W.!r had a phone or computer What happened to those items I Do you have di olf from work and what do lOU do on your days off Are you allowed to take breaks a work Ii you a,e no feeling well are you able to take time oil from work Has someone ever conlfolled your access to food and drink health care andfor medications Has someoni ever taken your i dentification papers passport or other personal documents kupred from The Polaris Pro/eel 1/umJn Tralfid;ing Recognize the Sign5 Avai/abie at polarisproject or rerngnize-signs In both child sex trafficking and IP P.rti affio tsM l.19etrator gain control by isolating victims from outside social support and terrorize victims through the use of emotional blackmail and/or physical and sexual violence Glamorizing and normalizing commercial sex are additional ways adolescents are enticed into sex trafficking often by traffickers use of peers for recruiting This may include peer recruiters who appear to be living the good life Pervasive themes in the literature indicate that a female age is her greatest vulnerability to being sex trafficked as a minor Vulnerable populations include children in the child welfare system and foster care runaways homeless individuals individuals living in impoverished communities seeking work migrant workers persons with limited English skills persons with disabilities socially marginalized individuals persons rooted in vulnerability to gender inequality situations and persons who identify as lesbian gay bisexual transgender or intersex Increasingly reports indicate that traffickers are preying on those with intellectual or other disabilities and using drugs or withholding medication and health care to manipulate victims into commercial sex Branding and tattooing are common and mark the trafficked person as property enabling the trafficker to claim ownership of the victim and signal other pimps to stay away CHALLENGES IN IDENTIFYING VICTIMS Identifying victims poses a significant challenge to researchers and professionals who provide medical or dental care interventions and refer resources because trafficked children and adults rarely self-identify Trafficked victims may underreport because they Lack access to legal or support services Fear retaliation from their traffickers against them or their family Have been conditioned to fear and distrust anyone other than their captors including law enforcement or other authorities Fear the consequences of being identified as illegal immigrants or criminals instead of victims Feel ashamed of their activities and how their families and communities will receive them if they return Feel a sense of hopelessness in escaping their captor and the emotional or financial indebtedness employed by their controlling trafficker Do not identify that they are being trafficked PSYCHOLOGICAL AND PHYSICAL COSTS Traffickers use intimidation and emotional entrapment to control victims including violence against the individual or their family and friends threats of deportation confiscation of identification documents shaming or guilt and trauma-bonding in which the trafficked person fears the trafficker yet feels relieved to be taken care of offered employment and allowed to live Trafficked individuals are routinely exposed to seasoning tactics such as withholding food water sleep or social contact and psychological trauma that enabled the trafficker to achieve submission increase dependence and reduce resistance Psychological entrapment often prevents victims from escaping even when opportunities arise Victims and survivors may experience multiple psychological conditions including severe post-traumatic stress disorder rape trauma syndrome the series of emotional physical and behavioral reactions experienced by rape victims and child sexual abuse accommodation syndrome in which children go through five stages of response to ongoing abuse including secrecy helplessness accommodation delayed disclosure and retraction In addition victims may have anxiety and/or nervous disorders psychosomatic syndromes eating disorders personality disorders depression coping substance abuse and subsequent addiction and thoughts of self harm or suicide Victims of human trafficking frequently present to medical and dental facilities with a variety of physical health needs including injuries from violence head and neck trauma sexually transmitted diseases STDs dental or orofacial conditions and matf 1s;t tjOOte us i m-p li Jjtn9 geif"WsrAl sr Wld li is ilfiil wi cfJ Read More https ofessionals Case Document Filed Page of PM Human Trafficking Red Flags for Dental Professionals Decisions in Dentistry multiple pregnancies and forced abortions Physical injuries to trafficked individuals are often:iill fjj Jdymd face including teeth and jaw fractures and mandibular dislocations consequently demand for dental care is one of many common needs of trafficked victims Neglected health conditions such as uncontrolled asthma hypertension diabetes malnourishment obesity addiction untreated skin infections/lesions untreated caries and periodontal disease and withholding medication or noncompliance with recommended therapies may be signs that trafficked individuals are being prevented from accessing care ORAL HEALTH PROFESSIONALS ROLE Victims may present for dental services as a result of restricted access to dental hygiene products or deleterious effects on oral health from sex or labor work as well as for cosmetic purposes Additionally a sex trafficker interest in seeking cosmetic dental services would most likely stem from a desire to make the victim more attractive to clients Thus the responsibility of identification relies on the provider ability to recognize the sometimes subtle signs of victimization and follow up with focused questions to assess immediate treatment and referral needs That said the role of oral health professionals in assisting victims of human ff I tra Ic Ing as not een extensive Iscusse In Iterature In some cases dentists and dental hygienists may be the first responders in rendering care to trafficked individuals A survey of U.S based survivors of human trafficking shows that while being trafficked were seen by a dentist along with other health care providers but few victims were identified by these clinicians Signs of abuse or other indicators of human trafficking warrant follow-up and a one-on-one conversation without the presence of the victims attendant The online version of this article provides examples of questions that can be used to assess whether a patient has been a victim of human trafficking while this is neither an exhaustive nor cumulative list it may prove helpful in the assessment process In recognition of the suspected frequency with which as yet unidentified trafficking victims are being seen in health care facilities efforts to educate clinicians about human trafficking have increased in last years At same time ocumentatIon ealt consequences and risks of human trafficking is improving as is science understanding of the gaps in health care providers knowledge about bl I I Is growing pro em Dentists menta eat wor ers I I I emergency room pro,essIona gyneco ogIsts or ot er specIa ty Id II ysIcIans an nurses an mI wives wou a ene It rom training designed to increase recognition of trafficking victims so an interdisciplinary response can be initiated CLINICAL STRATEGIES Separating the patient from the third party accompanying the individual to the health visit is a crucial first step in conducting screening questions about human trafficking A third partys refusal to allow the patient to be alone with the provider may indicate that he or she is not concerned with obtaining the best care for the patient but instead fears being divulged as a trafficker The patient can be asked if he or she requires an HUMAN TRAFFICKING CASE SCENARIOS The fo owing examp es represent scenarios of human trafficking that oral nealth profession I may encounter They also reflect individuals and relationships that do not nece.ssarity fit stereotypic profiles of victims and perpetrators which makes identification difficu I Scenario a 15-year-old girl is brought Into a denta office a new patient she is accomp nled by a woman who says she is her aunt and caring fo her because Bs mother and father died recently Initia ll is seen by the denta hygienist to start the medical i story and asse!.smenh The aunt reports t_hat she doesnt know det.tils of Bs medical history except that she ad an abortion this yea a sexually ransmitted disease and h,u some oken front teeth from falli down steps The aunt also reports that dropped ut of schoo this year and has been difficu to manage The gi rl appear shy and afraid of aun and asks to use the restroom The aunt appears nervous when eaves wfth the dentc1I hygienist who has offered to show her to he restroom The dunt follows them dOd yells at to hurry up and repeated asks the dental hygienist what can be done to flx eeth so they get bac to work soon Afte exrtlng the restroom the dent hygi nist asks If she Is OK or In need of lrnince but is app nsiv and se ims a r.iid of rece i ving I Sam rio a 25-year-old petit worn Ii brought into a dent I office by a husband and wife who are among the longest tenured families in he practice They report that is an undocumented migrant and does not ve any medical records passport or den iflcatlon documents She recent became a nny for the.Jr win 18-month-old sons and the family exp I ins they are wilHng to foot bl to get her decayed teet resto ed because she is such a wonderful help with their sons and 225good child care is hard to fTnd he coup says th,1t rs appearance frigh ens the chi dren a embarrasses hem in front of friend and family She does not make ye contact and appears to have mul ip faint bruises on her face neck and forearms She appears to be un ble to si wfth her back against the dental chair The coup reports he twin boys are quite rambunctious and a li tt ough on The couple states hat they can spe for Tin decisions made abou her teeth Increasingly it is recognized that dental providers may routinely encounter but inadvertent overlook Individuals who are present or previously ctims of um trafficking With this i mind it is prudent for clinicia to watch for i gns of abuse and/or human fflck i ng and ff er the app opriate treatment counseling resources a refe ra interpreter or prefers a male or female clinician It is also up to the clinicians judgment to enlist interpreter services if the pr al;l fesitt:lQffl i9atiPID iSa Melilei itw J,e 0Wvtim l:lfi I i 247t,-aibt:!iPfferua fii nter..m services by the person accompanying the patient may be a oo1Me flag indicating victimization https ofessionals Case Document Filed Page of PM Human Trafficking Red Flags for Dental Professionals Decisions in Dentistry Clinicians should not inquire about trafficking-specific details but should know their state-m!l fiQil1 for children and adults as well as vulnerable adults and when weapons are involved Oral health professionals are mandated to report their suspicions of abuse and neglect perpetrated against children under regardless of consent Detailed documentation of craniofacial injuries and other injuries identified during the dental examination should include descriptions locations duration and information pertaining to the cause If a patient divulges that he or she is a victim it is imperative to establish rapport acknowledge the presence of trauma symptoms respect an adult victims decision on whether he or she is ready and able to self-report and attend to the individuals immediate needs and safety Clinicians should not divulge personal addresses or contact information or attempt to harbor the trafficked person Unless legally mandated providers should not contact authorities without consent of an adult trafficking victim instead oral health professionals are advised to encourage self-reporting and refer the patient to the appropriate support services If the victim personal decision is in contrast with the health care provider a trauma-informed approach enables the trafficked individual to feel in control and respected perhaps for the first time Establishing this level of trust may provide an opportunity for the victim to potentially return when he or she is ready to escape the trafficking situation REFERRALS AND RESOURCES Compared to other victimized groups there are relatively few resources and long-term sustainable services for individuals identified as victims of human trafficking Trauma-informed programming is essential to the recovery and reintegration of survivors and requires an approach that effectively focuses on the physical and mental health consequences of human trafficking As noted Table provides resources for those who seek help or wish to report suspected cases of human trafficking It is imperative for dental teams to familiarize themselves with local resources such as housing legal assistance and trauma-informed care providers as well as their intake requirements residency gender or age This website uses cookies to improve your experience Well assume youre ok with this but you can opt-out if you wish Accept Read More https ofessionals Case Document Filed Page of PM CONCLUSION Human Trafficking Red Flags for Dental Professionals Decisions in Dentistry TA Flag for Id ntifying Hum an affic i Privacy Cookies Policy Indicators for lndividual in Question Work Cond it ions Is restricted in coming and going places as he/she wishes Is under age and providing commercial sex acts Is in the comme cia sex industry and has a handler/manager or pimp Wages are low or non-existent or paid only through tips Wo ks excessively long hours with little or no breaks Experiences stric rules or works under severe restrictions Was recruited with false promises egarding the work he/she would be Involved in and promfses for a better life education higher paying job or exciting opportunmes Wo ks all the time but is unable to pay off debt to afficker Wo ks or lives in settings ma ked by high secu ity measures cameras boarded or opaque windows bars on window and doors Psycho lo i cal Signs Fearful anxious depressed or nervous/paranoid ook i ng around before talking Extreme sta tle response Exhibits comba ti ve behaviors as a defens me han i sm Become anxious and appears distrustful of la enforcement when brought up i conversation Doesn make eje contact and appears very submissive or erly emotionally attached to 3rd party treme dependence on the 3rd party for living arrangements drugs affection Emot onless withdrawn posture Physkal Signs Unmet hea th and dental care needs Appears malnourished and dehydrated Branding or tattooing in high visible areas of body to show other pimps that he/she is owned by anotfler pimp Appears to have been icalty and/or sexually abased physically restrained confined or tortured Reports an unusually high numberof sexua partners Self-inflicted injur i es Addiction to subs ances Chronic medical conditions Multiple new or recurrent sexually transm itt ed diseases resents with inju ies from inadequate persona protective equipment in the workplace Lack of A utono and Self De te rm i na ion Has few or no personal be lo ngings Doesn control own money finances and doesn have a flnanciaVbank account Lack of passport immigrat i on or identifi ation documents turned them over to i s/her handler trafficker emp oyer or another person Is not permitted to speak or must seek permission to speak from 3rd party attend i ng appointment who does all the talking insists on being present or anslating and overrides the conversation with needs for osmetic treatment and not overall health care needs Has been renamed to show ownership by traffi ck er or to attract more buyers Lack of Connectedness Social Outlets and Long-Range ans Claims to be just visiting and unable convey where he/she is li ing States an unverifiable esidential address Doesn tknowv.t.era they are lack of kno.l ledge ofwhatdty te1,vn or even state she is in Loss of sense of time Lacking social contact outside of handler/trafficker out of touch with family and friends Doesnt express ng range goals or plans for future Difficulty in exp ain i ng what he/she does for fun or socia lly Doesnt discuss inviting friends ove to place of esidence th er Age appears falsified or discrepancy between reported and suspected age A arge discrepancy in age of victim to trafficker Accompanied by controlling and demanding person Accompanfed by th i rd party who is Interested in obta i i ng cosmet i dental work to improve victims appearance as in sex trafficking only and not i nterested in long-term treatment plan or preventive care A companied by th i rd party who offers to pay for all dental work In cash Adapred from The Po ar is Project Human Traff ic i ng Recognize the Signs Available a Human trafficking is a global public health problem and dental professionals have the opportunity to play an important role in identifying and lending support to victims Given the likelihood that dental teams will encounter victims who are seeking treatment under a variety of circumstance they should be prepared to identify respond and refer for intervention Clinicians should utilize the red flag indicators screening questions and specific general and oral health presentations commonly associated with trafficking-related injuries as triggers for interventions Oral health care is an important component of the interdisciplinary care necessary for addressing trafficking victims psychological and physical needs This website uses cookies to improve your experience Well assume youre ok with this but you can opt-out if you wish Accept Read More https ofessionals Case Document Filed Page of PM REFERENCES Human Trafficking Red Flags for Dental Professionals Decisions in Dentistry Privacy Cookies Policy U.S Department of State Trafficking In Persons Report June Available at Accessed July U.S Department of Justice National Strategy to Combat Human Trafficking January Available at Accessed July Miller-Perrin Wurtele SK Sex trafficking and the commercial sexual exploitation of children Women Therapy OBrien JE White Rizo CF Domestic minor sex trafficking among child welfare-involved youth an exploratory study of correlates Child Maltreat Polaris Project Human Trafficking The Victims and Traffickers Available at Accessed July National Center for Missing and Exploited Children Child Sex Trafficking Available at missingkids.org/lin6 Accessed July U.S Department of Justice The National Strategy for Child Exploitation Prevention and Interdiction A Report to Congress April Available at Accessed July Cole Sprang Sex trafficking of minors in metropolitan micropolitan and rural communities Child Abuse Neg Reid JA Entrapment and enmeshment schemes used by sex traffickers Sex Abuse National Human Trafficking Resource Center National Human Trafficking Resource Center NHTRC Data Breakdown United States Report Available at https://h mantrafficki ng hotli ne.org/sites/defa lt/files/N HTRC nited 20States 20Report 20USA _Ed Accessed July Macias-Konstantopoulos Human trafficking the role of medicine in interrupting the cycle of abuse and violence Ann Intern Med Cole Sprang Lee Cohen The trauma of commercial sexual exploitation of youth a comparison of CSE victims to sexual abuse in a clinical sample lnterpers Violence Jimenez Jackson AM Deye Aspects of abuse commercial sexual exploitation of children Curr Prob Pediatr Adolesc Health Care Varma Gillespie McCracken Greenbaum VJ Characteristics of child commercial sexual exploitation and sex trafficking victims presenting for medical care in the United States Child Abuse Neg Gibbs DA Hardison Walters JL Lutnick A Miller Kluckman Sevices to domestic minor victims of sex trafficking Opportunities for engagement and support Child Youth Serv Rev Hachey LM Identification and management of human trafficking in the emergency department Adv Emerg Nurs Logan TK Walker Hunt Understanding human trafficking in the United States Trauma Violence Abuse U.S Department of State United States Advisory Council on Human Trafficking Annual Report Available at state.gov/j/tip/263114.htm Accessed July Dovydaitis Human trafficking the role of the health care provider Midwifery Womens Health Nuzzolese Human trafficking role of oral health care providers Forensic Odontostomatol Lederer Wetzel The health consequences of sex trafficking and their implications for identifying victims in healthcare facilities Annals of Health Law Greenbaum VJ Commercial sexual exploitation and sex trafficking of children in the United States Curr Prob Pediatr Ado/esc Health Care Chaffee English A Sex trafficking of adolescents and young adults in the United States Healthcare providers role Curr Opin Obstet Cyneco OCallaghan MG Human trafficking and the dental professional Am Dent Assoc Blackiston Saving a life Recognizing the signs of human trafficking abuse and neglect ROH Chisolm-Straker Baldwin Gaigbe-Togbe Ndukwe Johnson PN Richardson LD Health care and human trafficking we are seeing the unseen Health Care Poor Underserved Baldwin SB Eisenman DP Sayles JN Ryan Chuang KS Identification of human trafficking victims in health care settings Health Hum Rights Powell.C Dickens Sto losa Training U,S health care professionals or hur:nan traffickinq wherE do we_qo from here This website uses cookies to improve your experience Well assume youre ol w1th this but you can opt-out 1fyou wish Accept Med Educ Online Read More tal-professionals Case Document Filed Page of PM Human Trafficking Red Flags for Dental Professionals Decisions in Dentistry Grace AM Lippert Collins et al Educating health care professionals on human traffi 200roor jl:are Schwarz Unruh Cronin Evans-Simpson Britton HE Ramaswamy Human trafficking identification and service provision in the medical and social service sectors Health Hum Rights Hemmings Jakobowitz Abas et al Responding to the health needs of survivors of human trafficking a systematic review BMC Health Serv Res Hopper Trauma-informed psychological assessment of human trafficking survivors Women Therapy Featured Image by Case Document Filed Page of PM Human Trafficking Red Flags for Dental Professionals Decisions in Dentistry Privacy Cookies Policy Load More Follow on lnstagram Home Issue Archive Advertising Opportunities Decisions in Dentistry All Rights Reserved This website uses cookies to improve your experience Well assume youre ok with this but you can opt-out if you wish Read More tal-professionals ISSN Accept
