Responding to the health needs of survivors of human trafficking: a systematic review

Stacey Hemmings, Sharon Jakobowitz, Melanie Abas, Debra Bick, Louise M Howard, Nicky Stanley, Cathy Zimmerman, Sian Oram, Stacey Hemmings, Sharon Jakobowitz, Melanie Abas, Debra Bick, Louise M Howard, Nicky Stanley, Cathy Zimmerman, Sian Oram

Abstract

Background: Despite the multiple physical and psychological health consequences associated with human trafficking, there is little evidence-based guidance available for health providers on assessing and meeting the health needs of trafficked people. We aimed to review literature that provided guidance or research on care provision for people who had been trafficked.

Methods: We conducted a systematic review and qualitative analysis of peer-reviewed and grey literature. Data sources included electronic databases, reference list screening, citation tracking, and expert recommendations. Documents were included if they reported on: 1) male or females (adults or children) who were currently or had previously been trafficked; 2) health interventions or service provision; 3) primary, secondary, tertiary or specialist post-trafficking services; and 4) World Bank high income countries. Two reviewers independently screened and quality appraised documents. Framework analysis was used to analyse extracted data.

Results: Forty-four documents were included, 19 of which reported findings of primary studies and nine of which exclusively addressed children. Evidence to inform the identification, referral and care of trafficked people is extremely limited. Within current literature on survivor identification, key indicators included signs of physical and sexual abuse, absence of documentation, and being accompanied by a controlling companion. Findings highlighted the importance of interviewing possible victims in private, using professional interpreters, and building trust. For provision of care, key themes included the importance of comprehensive needs assessments, adhering to principles of trauma-informed care, and cultural sensitivity. Further prominent themes were the necessity of multi-agency working strategies and well-defined referral pathways.

Conclusions: Human trafficking survivors require healthcare that is trauma-informed and culturally sensitive to their particular needs. Coordination is needed between health providers and statutory and voluntary organisations. Future research should generate empirical evidence to develop trafficking indicators for use by health providers, alongside validated screening tools, and evaluate the effectiveness of psychological interventions.

Keywords: Human trafficking; Qualitative; Systematic review; Violence.

Figures

Fig. 1
Fig. 1
PRISMA 2009 Flow Diagram

References

    1. International Labour Office, ILO Global Estimate of Forced Labour: Results and Methdology, International Labour Office, 2012: Geneva.
    1. United Nations, Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially Women and Children, Supplmenting The United Nations Convention Against Transnational Organised Crime. New York: United Nations; 2000.
    1. Oram S, et al. Prevalence and risk of violence and the physical, mental, and sexual health problems associated with human trafficking: systematic review. PLoS Med. 2012;9(5):e1001224. doi: 10.1371/journal.pmed.1001224.
    1. Abas M, et al. Risk factors for mental disorders in women survivors of human trafficking: a historical cohort study. BMC Psychiatry 2013:13(3):204. doi: 10.1186/1471-244X-13-204.
    1. Kiss L, et al. Health of men, women, and children in post-trafficking services in Cambodia, Thailand, and Vietnam: an observational cross-sectional study. Lancet Glob Health. 2015;3(3):e154–61. doi: 10.1016/S2214-109X(15)70016-1.
    1. European Parliament, Directive 2011/36/EU of the European parliament and of the council of 5 April 2011 on preventing and combating trafficking in human beings and protecting its victims, and replacing Council Framework Decision 2002/629/JHA, 2011. Brussels.
    1. Taskforce on the Health Aspects of Violence Against Women and Children, Report from the Harmful Traditional Practices and Human Trafficking sub-group: Responding to violence against women and children – the role of the NHS. 2010.
    1. Ross C, et al. Human Trafficking and Health: A Cross-Sectional Survey of NHS Professionals’ Contact with Victims. BMJ Open. 2015;5:e008682. doi: 10.1136/bmjopen-2015-008682.
    1. Viergever RF, et al. Health care providers and human trafficking: what do they know, what do they need to know? Findings from the Middle East, the Caribbean, and Central America. Frontiers. 2015:3(6). doi: 10.3389/fpubh.2015.00006. eCollection 2015.
    1. Joanna Briggs Institute, Joanna Briggs Institute Reviewers’ Manual 2011 Edition. Australia: University of Adelaide; 2011.
    1. Noblit GW, Hare RD. Meta-Ethnography: Synthesing Qualitative Studies. Newbury Park: Sage; 1988.
    1. Dixon-Woods M. Using framework-based synthesis for conducting reviews of qualitative studies. BMC Med. 2011;9(1):39–40. doi: 10.1186/1741-7015-9-39.
    1. Oliver SR, et al. A multidimensional conceptual framework for analysing public involvement in health services research. Health Expect. 2008;11(1):72–84. doi: 10.1111/j.1369-7625.2007.00476.x.
    1. Carroll C, Booth A, Cooper K. A worked example of “best fit” framework synthesis: A systematic review of views concerning the taking of some potential chemopreventive agents. BMC Med Res Methodol. 2011;11(1):1–9. doi: 10.1186/1471-2288-11-29.
    1. Ward DJ, et al. Using Framework Analysis in nursing research: a worked example. J Adv Nurs. 2013;69(11):2423–31.
    1. Ritchie J, Spencer L, O'Connor W, O'Connor W. Analysis: Practices, Principles and Processes. In: Ritchie J, Spencer L, editors. Qualitative Research Practices. London: Sage; 2003.
    1. Son M, et al. Barriers to Access, Disclosure, and Identification in Healthcare for Potentially Trafficked Youth in Vermont, in 142nd APHA Annual Meeting and Exposition. New Orleans: American Public Health Association; 2014.
    1. Taskforce on Trafficking of Women and Girls, Report of the taskforce on trafficking of women and girls. Washington DC: American Psychological Association; 2014.
    1. Baldwin S, et al. Human Trafficking Victims: At an Abortion Clinic Near You? 2009.
    1. Baldwin SB, et al. Identification of human trafficking victims in health care settings. Health & Human Rights. Int J. 2011;13(1):36–49.
    1. HM Government, Working together to safeguard children - safeguarding children who may have been trafficked, Department for Children Schools and Families. Nottingham: Department of Children Schools and Families; 2007.
    1. Platform 51, Identifying and supporting victims of human trafficking guidance for health staff. London: Department of Health; 2013.
    1. Dottridge M. Reference Guide on protecting the rights of child victims of trafficking in Europe. Geneva: UNICEF; 2006.
    1. Family Violence Prevention Fund, Turning Pain into Power: Trafficking Survivors’ Perspectives on Early Intervention Strategies, World Childhood Foundation, San Francisco: World Childhood Foundation; 2005.
    1. International Organization for Migration, The IOM Handbook on Direct Assistance for Victims of Trafficking, International Organization for Migration. Geneva: International Organization for Migration; 2007.
    1. Isaac R, Solak J, Giardino AP. Health Care Providers’ Training Needs Related to Human Trafficking: Maximizing the Opportunity to Effectively Screen and Intervene. Journal of Applied Research on Children: Informing Policy for Children at Risk. 2011:2(1)1–32.
    1. Lederer LJ, Wetzel CA, The Health Consequences of Sex Trafficking and Their Implications for Identifying Victims in Healthcare Facilities. Annals of Health Law, 2014:23(1)61–91.
    1. London Safeguarding Children's Board . London safeguarding trafficked children guidance. London: London Safeguarding Children Board; 2011. p. 26.
    1. Patel RB, Ahn R, Burke T. Human Trafficking in the Emergency Department. Western J Emerg Med. 2010;11(5):402–4.
    1. Sy E, et al. Responding to Commercially Sexually Exploited Children (CSEC): A Community Health Center’s Journey Towards Creating the First Primary Care Clinical CSEC Screening Tool in the United States. 2014.
    1. Welsh Assembly Government . Safeguarding children who may have been trafficked. Cardiff: Welsh Assembly Government; 2008.
    1. Borland R, Zimmerman C. Caring for Trafficked Persons: Guidance for Health Providers. Geneva: International Organization for Migration; 2009.
    1. Dovydaitis T. Human trafficking: the role of the health care provider. J Midwifery Womens Health. 2010;55(5):462–7. doi: 10.1016/j.jmwh.2009.12.017.
    1. Ahn R, et al. Human trafficking: Review of educational resources for health professionals. Am J Prev Med. 2013;44(3):283–9. doi: 10.1016/j.amepre.2012.10.025.
    1. Chisolm-Straker M, Richardson LD, Cossio T. Combating slavery in the 21st century: the role of emergency medicine. J Health Care Poor Underserved. 2012;23(3):980–7. doi: 10.1353/hpu.2012.0091.
    1. Zimmerman C, et al. The Health Risks and Consequences of Trafficking in Women and Adolescents: Findings from a European Study. London: London School of Hygiene & Tropical Medicine (LSHTM); 2003.
    1. Macy RJ, Johns N. Aftercare Services for International Sex Trafficking Survivors: Informing U.S. Service and Program Development in an Emerging Practice Area. Trauma Violence Abuse. 2011;12(2):87–98. doi: 10.1177/1524838010390709.
    1. Kung J. Sex trafficking: an exploration of clinician perspectives of the type and efficacy of treatment interventions. Massachusetts: Smith College School for Social Work; 2014.
    1. Aron LY, Zweig JM, LS. Newmark, Comprehensive Services for Survivors of Human Trafficking: Findingsfrom Clients in Three Communities. Washington DC: Urban Institute; 2006.
    1. Cecchet SJ. The Psychological Experience of Child and Adolescent Sex Trafficking in the United States: Trauma and Resilience in Survivors in School of Psychology, Family & Community 2012, Seattle Pacific University. p. 1–130
    1. Malloch M, Warden T, Hamilton-Smith N. Care And Support for Adult Victims of Trafficking in Human Beings: A Review, Scottish Centre for Crime and Justice Research. 2012. Stirling.
    1. Hom KA, Woods SJ. Trauma and its aftermath for commercially sexually exploited women as told by front-line service providers. Issues Ment Health Nurs. 2013;34(2):75–81. doi: 10.3109/01612840.2012.723300.
    1. Baráth A, Da Victoria Lobo A, Hoxha-Beganovic R, Jaffe PD, Motus N, Szilard I, Tudorache D, Venelinova R, Weekers J. The mental health aspects of trafficking in human beings: a set of minimum standards. Budapest: International Organization for Migration; 2004
    1. Pace P. Migration and the Right to Health: A Review of European Community Law and Council of Europe Instruments, International Organisation for Migration. Geneva: International Organization for Migration; 2007.
    1. Bennett-Murphy LM. Haunted: Treatment of a child survivor of human trafficking. J Infant Child Adolesc Psychother. 2012;11(2):133–48. doi: 10.1080/15289168.2012.673413.
    1. Hardy VL, Compton KD, McPhatter VS. Domestic Minor Sex Trafficking: Practice Implications for Mental Health Professionals. Aff J Women Social Work. 2013;28(1):8–18. doi: 10.1177/0886109912475172.
    1. Koleva M. Psychodrama and the treatment of women victims of human trafficking: research report. Int J Psychother. 2011;15(1):65–77.
    1. Clawson HJ, et al. Study of HHS programs serving human trafficking victims 2009, U.S. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation: Washington DC: Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation.
    1. Yakushko O. Human Trafficking: A review for mental health professionals. Int J Advan Counsel. 2009;31(3):158–67. doi: 10.1007/s10447-009-9075-3.
    1. Miller E, et al. Migration, sexual exploitation, and women’s health: a case report from a community health center. Violence Against Women. 2007;13(5):486–97. doi: 10.1177/1077801207301614.
    1. Abu-Ali A, Al-Bahar M. Understanding child survivors of human trafficking: A micro and macro level analysis. Procedia Soc Behav Sci. 2011;30:791–6. doi: 10.1016/j.sbspro.2011.10.154.
    1. European Commission, Recommendations on identification and referral to services of victims of trafficking in human beings. Strasbourg: European Commission; 2008.
    1. The Scottish Government, National guidance for child protection in Scotland. Edinburgh; The Scottish Government; 2014.
    1. Schloenhardt A, Klug B. Trafficking in persons and victim health in Australia. J Law Med. 2011;19(2):397–414.
    1. Riley R. Identifying and referring victims of human trafficking; training for healthcare professionals. 2014.
    1. Women’s National Commission, Still We Rise: Report from WNC Focus Groups to inform the Cross-Government Consultation “Together We Can End Violence Against Women and Girls”, Women’s National Commission. London: Women's National Commission; 2009.
    1. National Institute for Health and Care Excellence, Domestic violence and abuse: How health services, social care and the organisations they work with can respond effectively, PH50 NICE Public Health Guidance. 2014.
    1. World Health Organisation . Responding to Intimate Partner Violence and Sexual Violence against Women: WHO Clinical and Policy Guidelines. Geneva: World Health Organisation; 2013. pp. 1–56.
    1. Domoney J, et al. Mental health service responses to human trafficking: A qualitative study of professionals’ experiences of providing care. BMC Psychiatry. 2015;5:289. doi: 10.1186/s12888-015-0679-3.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する