When You Can’t Walk Away: Identifying Human Trafficking

Written by Karen Gregory, RN, CDIPC 

Human trafficking is defined as the use of force, fraud, or coercion to compel a person into commercial sex acts or labor against their will. There is a much higher level of awareness of the sex trafficking trade in the United States, but labor trafficking is also very prevalent. Often referred to as Modern Day Slavery, this industry generates 150 billion dollars each year in revenue, second only to the drug trafficking industry. In the United States alone, it is estimated that $45 million is spent on online sex trafficking, with 300,000 children at risk. These encounters generate approximately $200,000 each year, per victim.¹

Many believe that trafficking begins when the white van pulls into a neighborhood and heads to a street corner where children are waiting for the school bus. A child is then snatched and whisked away. While this scenario may happen, it is not the typical model used by traffickers. In fact, most trafficking victims know, may trust, and love their trafficker. Data on sex trafficking from the National Human Trafficking Hotline, from January 2020 – August 2022, provides the following statistics where the relationship to the trafficker was disclosed:

• 44% of sex trafficking victims were trafficked by a family member.
• 39% of sex trafficking victims were trafficked by an intimate partner.²

You may be surprised to learn that traffickers come from all walks of life. They may work as the CEO of a large corporation, be the neighbor next door, church leader, soccer coach, drug dealer, or pimp. They are brilliant at their craft and prey on vulnerable individuals. These individuals may be looking for financial security, housing, food, drugs, love, or acceptance. Several populations of individuals are considered “at-risk”.

Traffickers are experts at identifying at-risk individuals, developing relationships, and offering to provide solutions that will meet every need. While adults are victims of human trafficking, children and adolescents are at high risk of being targeted. Historically females are trafficked more frequently, but boys are now the fastest growing segment. Between the years 2004 – 2020, the number of boys identified as being trafficked more than quintupled.³

Make no mistake, this is an industry based on power, profit, and vulnerability. The trafficker utilizes a grooming process to gain full control over their victim and to manipulate them into cooperating in their own exploitation. Grooming occurs in several stages which are outlined below:

Targeting the victim or recruiting: As mentioned traffickers focus on vulnerable individuals. Areas of opportunity that have been identified include bus stations or truck stops, Youth Centers, Homeless Shelters, schools, and malls. Peer recruiters are often used to lure individuals into the business. With the increase in the use of social media, doors have opened for ease of access, especially to younger individuals. At any given time, there are 750,000 predators online, and in 2020, Polaris Project reports trafficking recruitment increased 125% on Facebook and 98% on Instagram.^4,5

Gaining trust: This is a critical step in the process. Traffickers excel at listening and use opportunities to form bonds over common interests. If the victim is suffering from low self-esteem or has no place to live or food, the additional attention is welcomed. Interestingly, information gained through these initial conversations may later be used against to victim to control their behaviors.⁴

Meeting Needs: Good things to come are promised by the trafficker. Money, food, housing, love, protection. The trafficker represents a protector, a rescuer, and a hero.⁴

Isolation: Once the relationship is established, the trafficker will begin to isolate the victim, becoming the center of their life. It is important to eliminate any voice of reason or dependence on other people so that the trafficker can control the victims’ behaviors and activities. This isolation also makes it more difficult for victims to reach out for help as the abuse grows more intense.⁴

Exploitation: Treating people unfairly to benefit from their work is a key part of the trafficking cycle. Victims may be pushed to participate in activities they are uncomfortable with, such as asking them to have sex with a friend of the trafficker. Over time victims are conditioned to believe these behaviors are normal. They may even feel that they owe their trafficker for all that has been done for them.⁴

Maintaining Control: This is important so that the victim will continue to complete tasks or activities for the trafficker. Strategies utilized to maintain this control, include continued isolation, physical or sexual abuse, and drug addiction.⁴

Many victims of human trafficking do not realize they have been trafficked until they have escaped the situation. The trafficker has spun such a web of deceit that the victim may feel their life is “normal” or that they are underserving of any other type of existence, which creates a complicated bond between the two. It is often not possible for them to just walk away. This is important to realize if you suspect your patient is being trafficked. Dental healthcare providers typically have very keen assessment skills which should be used with every patient. While there are consistent life circumstances that place people at risk for trafficking, regardless of the patient’s socio-economic status or ethnicity, ANYONE can be ensnared in trafficking.

The Substance Abuse and Mental Health Services Administration (SAMHSA) describes trauma as an event or circumstance resulting in physical harm, emotional harm, and/or life-threatening harm.⁶ Traumatic events can impact the brain and ultimately how a person responds to certain situations. As a result of past and ongoing trauma, many trafficking victims, who may be the patient in your chair, live in a constant state of fight or flight. Traumatic events live on in the brain’s emotional center as images, feelings, and sounds. An event, such as being laid back in a dental chair and sensing the loss of control may trigger emotions causing the patient to become defensive, anxious, difficult, and/or uncooperative.

Other indications of trafficking include:

If there is a suspicion of trafficking, this could be a dangerous situation for everyone involved, therefore, it is important to move forward carefully. Any suspicion of or known trafficking of anyone under the age of 18 must be reported to the proper authorities.

When a patient presents as difficult or uncooperative, step back and take the time to consider why. Has something occurred during the visit that triggered emotions from previous or current life events? Instead of asking “What is wrong with you?”, shift the focus to “What happened to you?” This may open the door to further conversation and allow treatment to continue. There are other actions that can create a higher level of safety, trust, and respect between the patient and dental healthcare worker. These include introducing yourself and your role, ensuring you are explaining everything that will be done during the visit, asking permission to touch the patient, and as often as possible positioning yourself at the same level as the patient.⁷

As a reminder, many individuals who are being trafficked are not aware they are in that situation. The role of the dental healthcare provider for individuals 18 and older is to assess the situation and provide emotional and physical support, along with helpful resources when indicated. Do not force anyone to report this situation if they are not ready to do so.

Human trafficking is a very complex business model. Lives are destroyed every day by individuals who exploit vulnerable children, women, and men. If they are seen as a patient in your practice, you just can’t walk away. Take the time now to collect resources that can be used with these patients.  You may be the one person who makes a difference and opens the door for escape!

Resources

Polaris Project: Largest movement to end human trafficking.

The National Human Trafficking Hotline: This confidential hotline provides an outlet for reporting trafficking situations.

Thistle Farms: Residential programs for women seeking to escape trafficking and prostitution.

Endnotes:

1. Titchen, K. (2016, May). How to spot human trafficking. TEDxGeorgeSchool. [Video]. TED Conferences. https://www.youtube.com/watch?v=hrxhptvEOTs
2. Polaris Project. (n.d.). Love and trafficking. https://polarisproject.org/love-and-trafficking/
3. U.S. Department of State. (2023). Overlooked for too long: Boys and human trafficking. https://www.state.gov/wp-content/uploads/2023/12/Overlooked-for-Too-Long-Boys-and-Human-Trafficking.pdf
4. Polaris Project. (2021, February 10). Love and trafficking: How traffickers groom & control their victims. https://polarisproject.org/blog/2021/02/love-and-trafficking-how-traffickers-groom-control-their-victims/
5. Polaris Project. (2020). 2020 U.S. National Human Trafficking Hotline statistics. https://polarisproject.org/2020-us-national-human-trafficking-hotline-statistics/
6. Substance Abuse and Mental Health Services Administration. (n.d.). Trauma and violence. U.S. Department of Health and Human Services. https://www.samhsa.gov/trauma-violence
7. Clark, C., Classen, C. C., Fourt, A., & Shetty, M. (2019). Trauma-informed nursing practice. Online Journal of Issues in Nursing, 24(2). https://ojin.nursingworld.org/table-of-contents/volume-24-2019/number-2-may-2019/trauma-informed-nursing-practice/