Wednesday, October 19, 2016

Responding to the health needs of survivors of human trafficking

(BMC Health Services Research)  This study aims to provide guidance to health providers on assessing and meeting the health needs of trafficked people through a qualitative analysis of peer reviewed and grey literature. Findings highlight the importance of interviewing possible victims in private, using professional interpreters, and building trust. For provision of care, key themes include the importance of comprehensive needs assessments, adhering to principles of trauma-informed care, and cultural sensitivity. Further prominent themes are the necessity of multi-agency working strategies and well-defined referral pathways.

Background
Human trafficking, which is estimated to affect 20.9 million people worldwide, is a serious crime and a violation of human rights. It involves the recruitment and transportation of people – often by the use of force, fraud, deception or coercion – for the purposes of exploitation. People may be exploited for forced sex work, domestic servitude, forced labour in industries such as construction, agriculture, fishing, factory labour, and in forced criminal activity.
Although evidence on health and human trafficking is limited, a systematic review found that human trafficking is associated with high levels of physical and sexual violence prior to and during trafficking and a range of health problems in the post-trafficking period. Studies with survivors identified high prevalence of depression, anxiety and post-traumatic stress disorder and symptoms such as headache, fatigue, dizziness, and back and stomach pain. A number of policy and guidance documents describe assistance measures to respond to the needs of trafficked persons, which include medical and psychological care, yet there still appears to be little evidence-based guidance available on how to plan, assess or provide for the health needs of trafficked adults and children. Healthcare professionals believe they have insufficient knowledge and lack confidence about how to respond appropriately to the needs of trafficked people. Recent research in health organisations in areas with high numbers of trafficking victims identified by police in England, suggest that 13 % of health professionals had been in contact with a person that they suspect has been trafficked. Such findings underlie the importance of professionals increasing their preparedness to identify potential cases of human trafficking and make appropriate referrals.

Care for survivors of human trafficking
Trafficked people may present to healthcare services with multiple physical, psychological, and social care needs. Responding to these needs requires that healthcare professionals adopt trauma-informed and culturally-sensitive approaches to working with victims of trafficking, conduct comprehensive health assessments, and collaborate with a range of agencies, including law enforcement and voluntary support services. Healthcare professionals’ ability to provide care and to refer for further support is likely to be affected by the provision of temporary or permanent legal residency (‘leave to remain’) to survivors of human trafficking and the availability of stable housing, financial, and legal support. Training for healthcare professionals should include information about in-country referral and support options for trafficked people and national reporting requirements, if applicable. At the local level, healthcare professionals should establish clear referral pathways and information-sharing protocols with relevant agencies.
Studies have highlighted the high prevalence and enduring nature of mental health problems among survivors of human trafficking in contact with support services. It is likely that psychological interventions to promote the recovery of trafficked people will need to take account of physical and sexual abuse during - and often prior to – trafficking and to work to stabilise physical and psychological health and to address social needs before commencing trauma-focused therapy. However, no studies were identified that tested the effectiveness of psychological interventions for trafficked people. The acceptability of evidence-based treatments for post-traumatic stress disorder (PTSD) and depression – such as cognitive behavioural therapy, narrative exposure therapy, and eye movement desensitization and reprocessing – among trafficked people is uncertain, as is the generalizability of therapies effective for other traumatised groups such as victims of domestic violence and asylum seekers and refugees. Research to investigate the efficacy of psychological interventions for survivors of human trafficking is urgently needed.

Conclusions

Fundamentally, human trafficking is a criminal form of extreme exploitation and abuse, from which individuals suffer multiple physical, psychological, and sexual and reproductive health problems. To foster recovery from this crime, healthcare professionals must be at the centre of responses for survivors. Responding to survivors’ needs requires that healthcare professionals adopt trauma-informed and culturally-sensitive approaches, conduct comprehensive health assessments, and participate in a reliable referral network, including law enforcement and voluntary support services. Training for healthcare professionals should include information about in-country referral and support options for trafficked people and national reporting requirements, if applicable. At the local level, healthcare professionals should establish clear referral pathways, trustworthy points of contact and information-sharing protocols with relevant agencies. Further health services research is urgently needed to enable health professionals to fully engage in identifying, referring and caring for victims of trafficking.


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