StreetLightUSA recently partnered with CommonSpirit Human Trafficking (HT) Response Program which makes this is an opportune time to highlight the frontline work that is taking place in the healthcare industry to stop sex trafficking. We talked with Holly Gibbs, System Director of the CommonSpirit Human Trafficking (HT) Response Program. In addition to being a System Director, Holly is also an advocate, an author, a survivor and has done workshops for law enforcement, testified before Congress, and serves on the advisory board for the McCain Institute for International Leadership. *
Holly, please tell us a little bit about CommonSpirit Health and what you do in your position.
CommonSpirit was created by the alignment of Dignity Health and Catholic Health Initiatives (CHI) in 2019. As a single ministry, CommonSpirit is one of the largest Catholic health care systems and the second largest nonprofit hospital system in the nation (as of 2019), with more than 1,000 care sites in over 20 states. CommonSpirit is committed to building healthier communities, advocating for those who are poor and vulnerable, and innovating how and where healing can happen—both inside its hospitals and out in the community. In support of its mission, CommonSpirit prioritized the alignment of two model programs: Dignity Health’s Human Trafficking (HT) Response Program and CHI’s Violence Prevention Initiative.
Together, these programs support the CommonSpirit Violence and HT Prevention & Response (VHTPR) Initiative. Through the alignment of Dignity Health and CHI, CommonSpirit is better positioned to both prevent and respond to violence and human trafficking in its facilities and communities. Prevention and intervention strategies, working together simultaneously, can help to eradicate violence. To learn more, visit https://commonspirit.org/united-against-violence/.
As the System Director of the CommonSpirit Human Trafficking (HT) Response Program, I oversee efforts to help ensure that physicians and staff are educated to identify patients and families who may be vulnerable to human trafficking or other types of abuse, neglect, and violence, and that physicians and staff are equipped to provide trauma-informed care and services to affected patients. Such care includes preventive education, intervention assistance, and continued trauma-informed health care and services.
Why do you think it is important for healthcare workers to be trained in detecting the signs of sex trafficking?
A 2014 study published in the Annals of Health Law found that nearly 88% of sex trafficking survivors reported some kind of contact with health care while they were being exploited.[i] A 2017 survey report from the Coalition to Abolish Slavery & Trafficking (Cast) found that over half of labor and sex trafficking survivors had also accessed health care at least once while being trafficked. Nearly 97% of that group indicated they had not been provided with information about human trafficking or related victim support or services while visiting the health care provider.[ii] These and other studies underscore the reality that health care providers are too often unprepared to identify and appropriately assist trafficked persons.[iii]
What policies has CommonSpirit Health instituted regarding violence and human sex trafficking in their hospitals?
The CommonSpirit Abuse, Neglect, and Violence Policy was designed in partnership with CommonSpirit physicians, nurses, social workers, chaplains, and other patient care leaders and staff across the system, many of whom were involved in case debriefings regarding patients who were impacted by various types of abuse, neglect, and violence, including human trafficking.
This policy is based on a wealth of information and learning gathered over the years such as:
A victim response procedure should not be designed in a way that assumes that red flags (i.e., risk factors or indicators) will be observed in triage. Red flags may be missed in triage and may be observed by staff at any time throughout the care process.
A victim response procedure should not be designed for one type of abuse, neglect, or violence. A patient may be experiencing multiple types of violence at once. For example, a patient may be experiencing labor trafficking, domestic violence, and sexual violence. Also, red flags for one type of violence are often similar to other types. As such, victim response procedures should be inclusive of any type of abuse, neglect, or violence that may have an impact on the patient population served by the health care system or facility.
It’s nearly impossible to write a victim response procedure that captures all variables that might occur when caring for a patient who is experiencing abuse, neglect, or violence. For this reason, education on a trauma-informed approach to patient care and services is essential. If a health professional provides patient care that reflects the guiding principles of a trauma-informed approach, then that professional is more likely to create a patient-centered experience and less likely to re-traumatize a patient.
To access an example clinical policy that is based on the CommonSpirit Abuse, Neglect, and Violence policy and that applies to both acute and non-acute care settings, please visit: https://commonspiritpophealth.org/programs-tools/violence-human-trafficking/.
What are some of the sex trafficking signs that healthcare workers watch for?
The American Hospital Association (AHA) created a poster called Human Trafficking: 10 Red Flags that Your Patient Could Be a Victim. This poster, adapted from materials developed by Catholic Health Initiatives (CHI), describes 10 red flags of human trafficking in the health care setting. These red flags are: clinical presentation and oral history don't match up; oral history is scripted, memorized, or mechanical; someone with the patient exerts an unusual amount of control over the patient or visit; patient appears fearful, anxious, depressed, submissive, hypervigilant, or paranoid; patient is concerned about being arrested or jailed; patient is concerned for their family's safety; evidence that care has been lacking for prior or existing conditions; tattoos or insignias of ownership; occupational-type injuries or physical ailments linked to the patient's work; and sexually transmitted infections. This poster can be downloaded here: https://www.aha.org/infographics/10-red-flags-your-patient-could-be-victim-human.
You have been doing this work in a hospital setting since 2015, what changes have you seen in this time period when it comes to awareness, detection and even the training of the hospital staff?
There are so many more resources available today to assist health care systems in adopting a Human Trafficking Response Program. I recommend that other systems use the educational modules, example policies and procedures, and other materials available to them. Some resources include the following:
American Hospital Association (AHA) Combating Human Trafficking: https://www.aha.org/combating-human-trafficking
Barrow Neurological Institute Domestic Violence Traumatic Brain Injury (TBI) Program: https://www.barrowneuro.org/centers-programs/concussion-brain-injury/support-programs/domestic-violence-traumatic-brain-injury-program/
Catholic Health Association Human Trafficking: https://www.chausa.org/human-trafficking/overview
CommonSpirit Violence and HT Prevention & Response Initiative, including the HT Response Program: https://commonspirit.org/united-against-violence/
CommonSpirit HT Response Program – Resources for Health Professionals: https://commonspiritpophealth.org/programs-tools/violence-human-trafficking/
HEAL Trafficking: https://healtrafficking.org/
Dignity Health Mercy Family Health Center “HT Medical Safe Haven Shared Learnings Manual”: https://dignityhlth.org/2Zs91sg
National Association of Pediatric Nurse Practitioners (NAPNAP) Human Trafficking Prevention: https://www.napnap.org/human-trafficking-prevention/
OTIP – SOAR to Health & Wellness Training Program: https://www.acf.hhs.gov/otip/training/soar-to-health-and-wellness-training
PATH Collaborative: https://pathcollaborative.org/
Why is a partnership with StreetLightUSA important to your efforts?
In order to ensure that health professionals are truly equipped to assist patients who are impacted by human trafficking or other types of abuse, neglect, and violence, CommonSpirit recognized that its efforts must reach beyond the walls of its facilities. CommonSpirit partners with public and private agencies in each of its communities, such as law enforcement, women’s shelters, and youth serving organizations, to help ensure a trauma-informed continuum of care for victims and survivors identified in patient care settings. StreetLightUSA is a key partner especially because the organization can support victims and survivors from any community in the country.
What role can businesses, legislators, and government agencies play in the ending of human trafficking?
Businesses should join their local community-based Human Trafficking Task Force to explore ways that they can help support efforts in the community to prevent trafficking, protect victims, and empower survivors. Legislators and government agencies should do the same – and explore ways to support policies that improve support and services to victims and survivors.
What can individuals do to help stop human trafficking?
Individuals should support local agencies that address human trafficking and other types of violence. Support can include volunteering or donations. I provide other tips for community members in my book, Walking Prey: How America’s Youth are Vulnerable to Sex Slavery.
Do you see that there has been real, measurable progress against sex trafficking?
With increased education and awareness, health professionals are increasingly identifying patients impacted by abuse, neglect, and violence, including human trafficking. It is critical to educate all healthcare staff on the realities of labor and sex trafficking – this includes security officers, patient registration personnel, and other staff who may observe red flags in the facility’s hallways, waiting areas, or parking lots. To access the CommonSpirit Human Trafficking 101: Dispelling the Myths educational module and other modules and resources, please visit: https://commonspiritpophealth.org/programs-tools/violence-human-trafficking/.
What is the importance of organizations like StreetLightUSA to your work, and to the girls who have been trafficked?
Organizations like StreetLight USA are vital to healthcare’s efforts to assist patients impacted by human trafficking. Without organizations like StreetLight USA, health professionals couldn’t support patients with accessing a trauma-informed continuum of care into the community.
Anything else you would like to add, Holly?
The success of the CommonSpirit Human Trafficking Response Program is completely dependent on the availability of trauma-informed victim support and services in its communities. I encourage anyone reading this to please support StreetLightUSA. As a survivor of sex trafficking myself, I appreciate StreetLightUSA and other agencies working hard to protect victims of abuse, neglect, and violence, and to empower survivors in the community.
(*A think tank in cooperation with Arizona State University whose mission is to "advance leadership based on security, economic opportunity, freedom, and human dignity, in the United States and around the world” and includes a focus on combatting human trafficking.)
[i] Laura J. Lederer and Christopher A. Wetzel, “The Health Consequences of Sex Trafficking and Their Implications for Identifying Victims in Healthcare Facilities,” Annals of Health Law. Volume 23, Issue 1 (Winter 2014). [ii] Coalition to Abolish Slavery & Trafficking, Identification and Referral for Human Trafficking Survivors in Health Care Settings, Survey Report, January 13, 2017 [iii] Chisolm-Straker, M., Baldwin, S., Gaïgbé-Togbé, B., Ndukwe, N., Johnson, P. N., & Richardson, L.D. (2016). Health care and human trafficking: We are seeing the unseen. Journal of Health Care for the Poor and Underserved, 27(3), 1220–1233. https://doi.org/10.1353/hpu.2016.0131