Browser history is impossible to clear completely and can be monitored. If you are in immediate danger or are worried that you might be monitored please call 1 (833) 900-1010 (Canada) or 1 (888) 373-7888 (USA).
By clicking the "Quick Exit" button on the top right side of the screen you will be redirected to a weather site immediately.
August 6th, 2025
When Recognition Becomes Action: A Healthcare Provider's Journey Through Complex Care
You're halfway through what seemed like a routine shift when something doesn't feel right. Maybe it's the way your patient won't make eye contact, or how the person accompanying them answers every question before they can speak. Perhaps it's the collection of small injuries that don't quite add up, or the profound fear you see when you mention needing to examine them privately. In that moment, your clinical instincts are telling you that someone may be exploiting this patient.
What happens next could help alter the trajectory of a person’s life. But it can also feel overwhelming, especially when you realize that the person sitting before you has likely endured trauma beyond what most of us can imagine. They've survived in a world where their humanity, sense of self and autonomy has been compromised or perhaps broken down, where trust has become dangerous, and where healthcare providers might represent safety or another threat.
In our previous post, we explored how to recognize the signs. Now, we dive into more challenging terrain–how to respond. How do you approach someone who has been psychologically manipulated, taught to distrust those who would help such as healthcare providers? How do you navigate the complex web of legal, ethical, and practical considerations that come with suspected trafficking cases?
Before we talk about what to do, we need to understand who we're trying to help. Patients in a trafficking situation carry trauma that goes far beyond what we typically encounter in healthcare settings. They live in states of chronic fear, hypervigilance, and mistrust that have been intentionally cultivated by their traffickers as tools of control. Their nervous systems have been rewired for survival in an environment where asking for help, or trusting authority figures could mean harm, either physical or psychological, to themselves or those they love.
This means that your patient's reactions will likely differ from anything you've experienced before. A simple request to change into a hospital gown might trigger a full panic response or an attempt to flee. Taking their vital signs might be perceived as a threat.3 Even your gentle bedside manner might be met with suspicion, anger, or complete emotional shutdown.
Their mistrust isn't personal, it's a survival mechanism that has kept them alive through repeated trauma. As one survivor explained: "I think that the health care workers being able to be trained in the way that they ask those questions [is important]. Because if you ask somebody questions off a monitor [it will affect] the way that they respond. But if they ask them in a more compassionate way... I think it would just be a huge difference in the way that care is given."1
Understanding this changes everything about how we approach care. We're not just treating medical conditions; we're providing what might be the first caring interaction this person has experienced in some time. We're offering them something they may have forgotten existed: dignity, respect, and choice.
To prevent re-traumatization, every interaction matters. Sit at eye level rather than speaking with them from above. Make appropriate eye contact without staring. Use language that doesn't judge or blame. Always ask permission before any physical contact, even for routine procedures like applying a blood pressure cuff. Include them in treatment decisions whenever possible. Offer small comfort measures like a warm blanket, food, or the opportunity to wash up. These seemingly minor gestures can help restore a sense of dignity and control that trafficking systematically destroys.3
The moment you suspect or confirm that your patient is trapped in human trafficking, everything changes. Your immediate priority shifts to ensuring safety for everyone involved, starting with yourself. This isn't selfish–it's necessary.
You and your facility should have a protocol into place before a situation occurs so you know what to do.
When becoming aware of a potential human trafficking situation, consider alerting your supervisor as soon as possible and then focus on maintaining a secure environment. Never place yourself in a dangerous situation. If you encounter threatening or disruptive behaviour from anyone accompanying the patient, immediately contact your facility's security team or local law enforcement. Remember that traffickers can be dangerous and violent. They have everything to lose if their victim escapes and may use violence to maintain control.3
The patient's safety is equally at risk. Consider having a team member remain with the patient until you can establish a comprehensive safety plan. This presence serves multiple purposes: it ensures the patient's wellbeing while you coordinate next steps, and it sends a message that they are now in a place where people care about their safety.
Once safety measures are in place, your next challenge is creating an environment where the patient trusts that they can speak freely. Survivors who have participated in focus groups consistently emphasize one critical point: the patient must be alone during any screening questions, no matter who is accompanying them.1
One survivor suggested, "If [a healthcare professional] thinks something is going on, order an X-ray whether or not she needs one or not. Split her up from [the potential controller]!"1
While you wouldn't want to actually order unnecessary procedures, you can use the concept creatively. Tell the patient they need to go for a routine procedure and take them yourself to somewhere private. Some facilities may have specific protocols or ordering codes that providers can use for this purpose.
However, creating physical space doesn't automatically create emotional safety. Sometimes traffickers tell these patients that they have "eyes and ears everywhere" and people on the inside of healthcare settings who will report back if they speak out.1 The patient sitting across from you might be convinced that you're part of the system that's been hurting them. Building trust against these odds is difficult but crucial.
If the patient arrived alone, watch for constant texting behaviours which may indicate that the trafficker is checking on the patient to determine their location and what's being discussed.3 These small details matter because they help you understand the level of control and monitoring the patient is experiencing even when their trafficker isn't physically present.
How you ask questions can determine whether a patient feels safe enough to disclose their situation. It's both an art and a science, requiring genuine compassion combined with specific techniques that research and survivor experiences have shown to be most effective.
Start with open-ended rather than yes-or-no questions. This allows patients to elaborate on their responses and gives you more information instead of quick, guarded answers. While this is a great place to begin, even if patients self-identify as being trafficked, many won't disclose what's happening to them voluntarily.3
One survivor emphasized the importance of asking assessment questions in a warm, trauma-informed manner: "I think that the health care workers being able to be trained in the way that they ask those questions [is important]. Because if you ask somebody questions off a monitor [it will affect] the way that they respond. But if they ask them in a more compassionate way... I think it would just be a huge difference in the way that care is given."1
However, avoid asking outright if they're being trafficked, as blunt questions may shut down trust and communication. Also, many people experiencing exploitation don’t identify with the term “trafficking” as describing their situation.3 They may think they’re in a relationship, repaying debt, helping family or simply have no alternative.
Instead, focus on concrete experiences. Ask about their ability to come and go freely. Ask about their living conditions, whether they sleep in a bed or somewhere else. Ask if they have to ask permission for basic human needs like eating, sleeping, or using the bathroom.
Don't be afraid of offending a patient by asking questions about safety and control. If asked without judgement and with genuine care and they don’t feel exploited, it’s unlikely they’ll be offended. And if they are being trafficked, it could make a big difference for them that someone showed genuine concern. Questions like "Are you safe at home?" or "Is anyone physically harming you?" may open doors for disclosure that might otherwise remain closed.
Some people trapped in trafficking have highly visible tattoos that signify ownership: crowns, dollar signs, chains, "property of," and bar codes. These aren't fashion choices. In some cases, bar code tattoos can lead a trafficker who finds a runaway survivor back to the original "owner" where they're resold. Don't hesitate to ask about tattoos, but keep your questions open-ended: "What does that tattoo mean or represent?"3
These questions gently explore where someone lives or stays, what their routines look like, and whether their basic needs are being met.
These questions focus on power dynamics, freedom of movement, and how a person’s choices are respected (or not).
These questions gently explore feelings in relationships, especially when there may be confusion, attachment, or emotional coercion.
These questions focus on financial control, possession of ID, and isolation from social supports — all potential signs of coercion.
These questions gently surface manipulation, fear, and exploitation — including forced labour or survival-based decisions.
These questions explore trust, belonging, and whether the person feels emotionally or socially supported.
If your questioning confirms what you suspected, the next step is addressing immediate needs with a holistic approach that encompasses mind, body, and spirit. The level of care available will differ based on your setting, but all medical treatment that can be rendered within your scope should be completed.3
Treat physical trauma (e.g. burns, lacerations, fractures, internal injuries, wound care, etc.), and screen for sexually transmitted infections, pregnancy, substance use, and suicidal ideation. If (and only if) permission is given, you can also provide forensic evidence collection. Provide immediate care wherever you can, referrals to a hospital-based social worker, crisis advocate, or trafficking response team, and offer safe discharge planning if the patient is in danger.
You may observe poor hygiene if those trapped in trafficking haven't been allowed to shower, brush their teeth, or change their clothes for extended periods. Traffickers typically withhold food, appropriate clothing, and medical care as methods of control.3 Treat for dehydration or malnutrition and care for poor hygiene-related conditions (e.g. skin infections, lice, abscesses, etc.).
The mental health assessment is equally crucial. Many of these patients experience depression, suicidal ideation, anxiety, panic attacks,, self-harming behaviours, feelings of guilt or shame, post-traumatic stress disorder, hostility, lack of emotional responsiveness, fear, withdrawal, and feeling detached from themselves (disassociation).3 Provide crisis intervention and psychological first aid, and/or refer to on-call psychiatric or social work teams.
Proper, trauma-informed documentation is also essential and means recording injuries and patient information accurately and respectfully, using neutral, objective language without assumptions. It includes detailed descriptions of injuries (e.g., “3 cm bruise on left forearm, purple and swollen”), the patient’s own words when shared (e.g., “Patient states, ‘He hit me with a belt’”), and observations of their emotional state—while always respecting consent and avoiding speculation. This approach ensures medical and legal accuracy while prioritizing the patient’s dignity and safety.
Once immediate needs are addressed, you face one of the most complex aspects of trafficking responses: reporting. The legal and ethical landscape here is nuanced, and making the wrong decision can put your patient in greater danger.
Not all trafficking situations require mandatory reporting. If you're treating a patient for serious injury due to a crime, or if you determine that the patient isn't competent to make their own decisions, you must contact local law enforcement. But for competent adult patients, the situation becomes more complex.
Ultimately, the decision to report to law enforcement should remain with the patient. They must give consent. This may seem counterintuitive when you know someone is being victimized, but there are crucial reasons for this approach. The trafficker may have told the patient that trying to leave could result in harm to their family or themselves. They may have been told that contacting authorities could result in arrest or deportation. Similar to domestic violence situations, the most dangerous time for the patient occurs when they try to leave.3
Respecting and abiding by the patient's decision if they refuse a request to call law enforcement isn't abandonment–it's trauma-informed care. Keeping patients involved in the process reduces the chances of re-traumatization through healthcare professional interference or removal of control over their own decision-making.3
However, some situations do require mandatory reporting regardless of patient wishes. All states, provinces, and territories require reporting to child protective services in addition to local law enforcement in cases of child (under age 18) sexual exploitation, assault or abuse. Remember that there is no such thing as a child prostitute–only child sexual abuse or paid assault, as according to the law, children can never consent to paid sex, so it’s always illegal. Trafficking of the elderly requires reporting to state adult protective services or elder abuse agencies. For adults with developmental disabilities, contact adult protective services.3
When reporting is appropriate, consider calling the National Human Trafficking Resource Center in the US or the Canadian Human Trafficking Hotline in Canada together with your patient. These national referral lines can assist in finding local resources and developing a safety plan that's acceptable to the patient.2
Most hospitals offer interprofessional services like social work, behavioural health counselors, trauma recovery counselors, and care management to address the needs of the patients. But many urgent care centers, outpatient clinics, provider offices, and outpatient testing centers don't have those resources. They might not be able to offer sexual assault examinations performed by forensic nurse examiners for patients who've experienced sexual exploitation.3
If a patient chooses to accept help when visiting a setting with limited resources, consider transferring them to the local emergency department via law enforcement or ambulance. Discourage them from driving themselves or having someone else drive them. If your setting is on a hospital campus, escort the patient to the ED in a wheelchair with security accompanying both of you.3
A smooth handoff requires providing a thorough report to the receiving clinician. Explain the human trafficking situation, treatment already completed, and further healthcare needs. Advance notice allows the ED time to prepare so the patient doesn't have to sit in the general waiting room. You want to immediately settle them into a treatment area to ensure privacy and prevent the trafficker from knowing the patient's location.3
After addressing physical and mental health needs, connect with whoever in your organization is responsible for conducting warm handover referrals: social workers, trauma recovery teams, or care manager RNs. This process links the patient directly with human trafficking service providers through personal introduction, creating a sense of safety that encourages acceptance of help.3
Some of the most heartbreaking cases are when patients in trafficking decline help. Don't judge this decision. Instead, try to understand it. Some patients may not even recognize that they're in a trafficking situation. If they grew up in violent households or experienced child sexual abuse, they may see their current lives as normal. Ongoing physical violence or continuing sexual exploitation may have convinced them that they're only good for one thing.3
They also may feel that now isn't the right time to leave. Remember, the most dangerous time for humans trapped in trafficking is when they leave. Some patients develop powerful psychological bonds with their traffickers, identifying with them, developing trust and affection for them, and even falling in love with them. This trauma bonding might seem irrational to outsiders, but avoid making negative comments about the trafficker. Keeping your focus on the patient proves more successful for helping them leave the situation.3
If the patient refuses help, encourage them to call a local human trafficking agency. Provide them with the confidential National Human Trafficking Hotline number. Give them contact information for your social work team or trauma recovery specialists if available. If they refuse this contact information too, provide them with a business card or "shoe card" with phone numbers for human trafficking agencies to place in their shoe, where a trafficker is less likely to see it.3
Continue to show support. Remind them that you care about their wellbeing and that the hospital is a safe place.3
Write them a prescription for a follow-up medical visit. While a human experiencing trafficking may not seek help on a first visit, they may be ready to open up at a later visit.
The reality is that helping those experiencing trafficking requires more than individuals. It requires systems, partnerships, and networks that can provide comprehensive care. This means building relationships with law enforcement, social services, legal aid organizations, and community-based organizations that specialize in trafficking response. These partnerships strengthen your ability to provide comprehensive, coordinated care throughout a survivor’s recovery journey.
Regularly communicate with partners to stay updated on available services and changes. Consider establishing formal protocols for referrals and follow-up care to ensure continuity of support.
It's important to be "referral-ready." Only offer what you can realistically provide, and have information available in the survivor’s preferred language about legal, health, shelter, social, and safety services. When giving referrals, be discreet–visible information could pose a danger to the person if found by a trafficker.
One of the major gaps in the anti-trafficking movement is the lack of a coordinated and reliable referral system. Resources are often fragmented, difficult to navigate, and yet heavily rely on one another to meet survivors’ complex needs. Survivors may not know where to turn for help, face confusing application processes, and are often retraumatized by having to repeatedly share their story. Referral lists are frequently outdated or include services that are not trauma-informed, and some survivors never hear back or are told to wait—despite needing immediate support. This lack of clarity and connection can result in long delays before survivors are matched with the right services.
To help address these challenges, we are actively developing a safe, fast, and easy-to-use platform that connects survivors and service providers to up-to-date information about partner organizations and available services. This platform is one step toward a more coordinated, survivor-centered response—and represents how the anti-trafficking field must continue to evolve to meet real-world needs.
Despite progress in trafficking awareness, significant gaps remain. According to Polaris survey data, 57 percent of trafficking survivors reported they were never asked any trafficking or abuse screening questions by healthcare professionals during their exploitation.1 These are gaps we can close through training and awareness.
But when training is done right, it makes a profound difference. One survivor shared her experience with an anesthesiologist who exemplified trauma-informed care: "I had an anesthesiologist who called me the night before a major surgery and spent a whole hour talking to me so I could get used to her voice. She said, 'I know you have complex trauma background, this is my protocol for complex trauma...' The next day when I came in for surgery, she spent a whole hour with me, prepping me and helping me feel safe... When I came out of that surgery, it was amazing, I felt comfortable and protected. Her sensitive, trauma-informed care made a difference."1
This is the gold standard we should all strive for: care that recognizes trauma, responds to it appropriately, and helps restore a sense of safety and dignity to people. However, this approach could likely feel impossible - especially to Canadian healthcare workers, whose time is already stretched to the breaking point. With chronic understaffing, overwhelming patient loads, and mounting administrative burdens, many healthcare professionals are already working beyond their capacity just to maintain basic care standards. The prospect of adding another layer of responsibility or process to their daily routines may seem not just challenging but genuinely unattainable, given the current strain on the system and the exhaustion many workers are experiencing after years of unprecedented demands on their time and energy.
Healthcare professionals working across diverse settings such as hospitals, outpatient clinics, provider offices, public health agencies, community centers, and long-term care facilities are uniquely positioned to help those who are experiencing trafficking. We encounter people in vulnerable moments when they might be willing to accept help.
But the solution for assisting survivors in healthcare settings is multifaceted. We can make an enormous difference by understanding and remaining alert for indicators of trafficking, but systems must be put in place to ensure that survivors are not just recognized and well-treated, but treated with dignity and provided with the continuum of health services and support they need to find and reclaim their freedom.
This means pursuing education about human trafficking, victim identification, and appropriate actions. It means disseminating this information widely to our coworkers, our community, and our families. It means placing pamphlets and posters in waiting and exam rooms so people in trafficking have easy access to resources. It means building partnerships with anti-trafficking organizations and maintaining updated referral networks.
Most importantly, it means recognizing that every interaction with a person caught in trafficking is an opportunity to provide something they may not have experienced in a very long time: compassionate, competent care from someone who sees them as a human being worthy of dignity and respect.
The fight against human trafficking is complex and ongoing, but healthcare providers are on the front lines of hope. When we combine clinical expertise with trauma-informed approaches and strong community partnerships, we become part of the solution to one of the most serious human rights violations of our time. In those moments when recognition becomes action, we have the power to support someone on their journey from survival to freedom.
.svg){kind=small}
