An Introduction to Human Trafficking

An Introduction to Human Trafficking
Training for Employees, Volunteers, and Service Providers of facilities licensed under Chapters 243 and 245, Health and Safety Code Developed by the Texas Human Trafficking Prevention Task Force

Training Mandate Pursuant to House Bill 416 (84th Regular Session), this training has been developed and provided to each person who: Is employed by, volunteers at, or performs services under contract with: An abortion facility licensed under Chapter 245, Health and Safety Code; or An ambulatory surgical center licensed under Chapter 243, Health and Safety Code, that performs more than 50 abortions in any 12-month period; and Has direct contact with patients of the facility.

Importance of Training
Over the course of completing their normal duties, several types of professionals are likely to encounter potential human trafficking victims. Such professionals may work for: Social service organizations Law enforcement organizations Health care providers “Health care providers, as one of the few groups of professionals likely to interact with trafficked victims while they are still in captivity, have the opportunity to screen, identify and intervene.” U.S. Department of Health & Human Services, Office of Refugee Resettlement. “Rescue & Restore Campaign Tool Kits”. Retrieved on November 17, 2015, from Isaac, Reena, Jennifer Solak, and Angelo P. Giardino “Health Care Providers’ Training Needs Related to Human Trafficking: Maximizing the Opportunity to Effectively Screen and Intervene”. Journal of Applied Research on Children. 2(1): 8. Retrieved on November 17, 2015, from

Purpose of this Training
Empower individuals to: Recognize risk factors and indicators related to human trafficking Identify potential human trafficking victims and report as legally required Provide a foundation to: Share knowledge with colleagues, parents, and community members Engage in local prevention efforts

Objectives This training is designed to help individuals subject to this training: Understand the realities of human trafficking Understand risk factors and vulnerabilities related to human trafficking Understand child trafficking Understand recruitment Understand human trafficking indicators in the clinical setting Understand how to respond to victims of trafficking and report as appropriate Take next steps

Objective Understand the realities of human trafficking
8 percent complete

What is Human Trafficking?
“Human trafficking is a modern-day form of slavery involving the illegal trade of people for exploitation or commercial gain.” -United States Department of Homeland Security United States Department of Homeland Security. “What is Human Trafficking.” Blue Campaign. Retrieved on November 17, 2015, from

Understanding Human Trafficking
Human trafficking is categorized as: Labor trafficking Sex trafficking A crossover of both labor and sex trafficking Human trafficking can be prosecuted under federal or state law. Human trafficking is about exploitation and does not have to involve movement of a person. Labor Trafficking Sex Trafficking Texas Attorney General, Texas Human Trafficking Prevention Task Force. September, Introduction to Human Trafficking: A Guide for Criminal Justice Professionals, p. 3, 5-9. Retrieved April 9, 2014, from Human Smuggling and Trafficking Center. December Domestic Human Trafficking: An Internal Issue, p. 4. Retrieved July 29, 2014,

Human Trafficking Victims
“Since the passage of the Trafficking Victims Protection Act (TVPA) in 2000, law enforcement investigators, social service providers, and community leaders have reported cases of forced labor, debt bondage, involuntary servitude, and sex trafficking, impacting a diverse range of populations including men, women, and children, who are U.S. citizens, permanent residents, or foreign nationals.” -U.S. Department of Health and Human Services United States Department of Health and Human Services, Administration for Children, Youth and Families. September Guidance to States and Services on Addressing Human Trafficking of Children and Youth in the United States, p. 1. Retrieved July 2, 2014, from

Trafficking Can Occur Anywhere
Our cities and towns Our neighborhoods Our schools Our foster and group homes Our shelters Our malls and parks Our online social networking A victim can be trafficked without ever leaving their home or community. Adapted from: The CNN Freedom Project. Amanda Kloer. March 15, “5 Things to Know about Human Trafficking.” Retrieved June 6, 2014, from United States Department of Health and Human Services, Administration for Children, Youth and Families. September Guidance to States and Services on Addressing Human Trafficking of Children and Youth in the United States, p. 1 and 4. Retrieved July 2, 2014, from United States Department of Education, Office of Safe and Drug-Free Schools. No Date. Human Trafficking of Children in the United States, A Fact Sheet for Schools. Retrieved July 3, 2014, from

Industries with Known Trafficking Cases
Labor Trafficking Sex Trafficking Agriculture, manual labor, or landscaping Commercial sex/prostitution Construction Residential brothels Domestic servitude Massage parlors Restaurants and food service Internet-based commercial sex Factories Sexually oriented business, hostess and strip clubs Peddling or begging Escort services Sales crews Truck stops Hospitality and tourist industry Pornography Nail salons Fake modeling agencies Carnivals Restaurants/bars Gas stations Cleaning services Adapted from: United States Department of State. June Trafficking in Persons Report, p Retrieved July 2, 2014, from United States Department of Health and Human Services, Administration for Children, Youth and Families. September Guidance to States and Services on Addressing Human Trafficking of Children and Youth in the United States, p. 1. Retrieved July 2, 2014, from United States Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. August Human Trafficking Into and Within the United States: A Review of the Literature. Heather J. Clawson, Amy Solomon, and Lisa Goldblatt Grace, p Retrieved June 20, 2014, from Polaris. No Date. “Labor Trafficking in Agriculture.” Retrieved November 2, 2015, from Polaris. No Date. “Domestic Work.” Retrieved June 6, 2014, from Polaris. No Date. “Labor Trafficking in the Restaurant Industry.” Retrieved November 2, 2015, from Polaris. No Date. “Hospitality Industry.” Retrieved November 2, 2015, from Polaris. No Date. “Peddling Rings, Sales Crews, and Begging Rings.” Retrieved June 6, 2014, from Polaris. No Date. “Hostess/Strip Clubs-Labor Trafficking.” Retrieved November 2, 2015, from Polaris. No Date. “Factories/Manufacturing.” Retrieved July 2, 2014, from Polaris. No Date. “Other Industries.” Retrieved November 2, 2015, from Illinois Department of Human Services. No Date. Human Trafficking Victim Dynamics. Retrieved November 2, 2015, from

Trafficking versus Smuggling
Crime against a person Crimes against a country Contains an element of coercion (unless a child is under 18) No coercion Exploitation and/or forced labor Illegal entry into the country Does not require any movement of the victim Involves illegally moving someone across an international border Persons are seen as victims (one cannot consent to be a victim) Persons are seen as criminals *Smuggling can become trafficking if exploited after a border crossing United States Department of Homeland Security. January 16, Fact Sheet: Human Trafficking and Smuggling. Retrieved June 6, 2014, from Human Trafficking Human Smuggling

Who are the Traffickers?
Traffickers can be anyone: Men or women Parents or family members Neighbors Boyfriends/girlfriends Peers Employers Brothel owners Organized crime participants/gang members Adapted from: Polaris. No Date. “The Traffickers.” Retrieved June 6, 2014, from Photo: National Crime Prevention Council. Resources. “Unaware Victims.” Retrieved July 18, 2014, from

Anyone Can be a Trafficker: Media Reports
A Houston trafficking ring forced minors to work in businesses labeled as massage parlors, bikini bars, spas, etc. The victims could not keep any earnings, making them financially dependent on their traffickers. In Fayetteville, NC, a mom pled guilty to sex trafficking her 5-year-old daughter to pay off a $200 debt. In White Plains, NY, three members of a suburban family were convicted of assault and labor trafficking after they forced a woman into domestic servitude. U.S. Attorney’s Office, Southern District of Texas. January 7, “Three Sentenced in Massive Domestic Sex Trafficking Case.” Retrieved November 2, 2015, from WRAL.com. October 18, “Mother Pleads Guilty in Shaniya Davis’ Death.” Retrieved June 24, 2014, from Wall Street Journal Online. February 27, “3 Relatives Convicted in NY Labor Trafficking Case.” Retrieved June 20, 2014, from

The Economics of Human Trafficking
There are two primary factors that drive human traffickers: high profits and low risk for the trafficker. Annual illegal profits worldwide from human trafficking are estimated at $150.2 billion. Polaris. No Date. “The Traffickers.” Retrieved June 6, 2014, from International Labour Office Profits and Poverty: The Economics of Forced Labor, p Retrieved May 22, 2014, from

Trafficking is Happening in Texas
In a recent report from the National Human Trafficking Resource Center (NHTRC): Texas was 2nd to California in the number of calls to the hotline reporting a tip or requesting assistance. Texas is consistently in the top tier of states in both number of calls to the hotline and potential cases along with states such as California and Florida. New York and Ohio are also in the top five. National Human Trafficking Resource Center (NHTRC). Annual Report, p. 3. Retrieved October 22, 2015, from

A Snapshot of Human Trafficking In Texas
Amarillo and Odessa – A man was sentenced to 26 years in federal prison for sex trafficking. He used social media to lure a 14 year-old Houston girl into trafficking. Dallas – Five individuals were charged for a forced labor scheme. They confiscated identification documents from a woman, physically threatened her, and required her to provide labor and services for them. Madisonville – A woman was convicted for sex trafficking and compelling prostitution, including at least one child. The woman provided the victims with a place to live and then made them engage in prostitution. El Paso – A juvenile probation officer and five suspected gang members were convicted of sex trafficking for forcing juveniles and adults to engage in prostitution. Amarillo and Odessa Amarillo.com. Aziz Musa. September 25, “Amarillo man sentenced in Odessa sex trafficking case.” Retrieved July 3, 2014, from El Paso United States Attorney’s Office, Southern District of Texas. January 20, “Jury Convicts Three Gang Members and a Former El Paso County Juvenile Probation Officer of Federal Sex Trafficking Charges.” Retrieved on January 29, 2015, from Houston United States Attorney’s Office, Southern District of Texas. October 14, “Three Sentenced to Federal Prison for Forcing Labor and Distributing Pirated/Counterfeit CDs and DVDs.” Retrieved June, 19, 2014, from Mission United States Attorney’s Office, Southern District of Texas. August 23, “Mission Bar Owner Sentenced to Prison for Sex Trafficking Minors.” Retrieved November 2, 2015, from Madisonville Texas Attorney General’s Office. October 31, “Texas Attorney General’s Office Secures Conviction, Prison Term in Madison County Human Trafficking Case.” Retrieved June 19, 2014, from Dallas United States Department of Homeland Security. February 8, “5 Charged in Forced Labor/Harboring Conspiracy.” Retrieved June 19, 2014, from Mission - A bar owner in Mission, Texas, was sentenced to 30 years in prison for a trafficking scheme that forced undocumented teenagers to work at a local bar without pay and provide prostitution services to customers. Houston – Three people were sentenced for a labor trafficking scheme that targeted immigrants. Victims were forced to work off their smuggling debt by selling pirated CDs and DVDs and were subjected to assaults, threats against themselves and against family members. This is a sample of media reports from around the state. Additional cases have been reported in other areas.

Labor Trafficking Under Texas Law: Adult and Children
Labor trafficking occurs when a person: ACTION: Knowingly traffics another person MEANS: Utilizes force, fraud, or coercion in cases involving children and adults PURPOSE: With the intent that the trafficked person engage in forced labor or services Traffics Force Fraud Coercion Forced labor or service Transports, entices, recruits, harbors, provides, obtains, or maintains Physical restraint or harm False promises regarding employment, wages, working conditions or other matters Threats of harm or physical restraint to any person if they fail to perform a certain act Any work or service performed by an individual against their will Texas Penal Code chapter 20A (trafficking of persons). Adapted from: Idaho State Department of Education Human Trafficking: Protecting Idaho’s Youth, PowerPoint Slide 6. Retrieved June 20, 2014, from United States Department of Health and Human Services, Administration for Children & Families, Office of Refugee Resettlement. August 6, Fact Sheet: Labor Trafficking. Retrieved July 9, 2014 from

Labor Trafficking: Adults and Children
Can occur in settings such as: Fields (harvesting crops) Domestic households (cooking, cleaning, childcare, caring for elders, or gardening) Restaurants or bars Motels and hotels Traveling sales or peddling crews (selling magazines, candy, beverages, or household products) Entertainment venues such as concerts, traveling fairs, circuses, or carnivals Polaris. No Date. “Labor Trafficking in Agriculture.” Retrieved November 2, 2015, from Polaris. No Date. “Domestic Work.” Retrieved June 6, 2014, from Polaris. No Date. “Labor Trafficking in the Restaurant Industry.” Retrieved November 2, 2015, from Polaris. No Date. “Hospitality Industry.” Retrieved November 2, 2015, from Polaris. No Date. “Peddling Rings, Sales Crews, and Begging Rings.” Retrieved June 6, 2014, from Polaris. No Date. “Other Industries.” Retrieved November 2, 2015, from See also: United States Department of State. June Trafficking in Persons Report, p Retrieved July 2, 2014, from United States Department of Health and Human Services, Administration for Children, Youth and Families. September Guidance to States and Services on Addressing Human Trafficking of Children and Youth in the United States, p. 1. Retrieved July 2, 2014, from Illinois Department of Human Services. No Date. Human Trafficking Victim Dynamics. Retrieved November 2, 2015, from

Sex Trafficking Under Texas Law: Adult
Adult sex trafficking occurs when a person: ACTION: Knowingly traffics another person MEANS: Utilizes force, fraud, or coercion in cases involving adults PURPOSE: With the intent that the trafficked person engage in commercial sex acts Traffics Force Fraud Coercion Commercial Sex Acts Transports, entices, recruits, harbors, provides, obtains, or maintains Physical restraint or harm False promises regarding employment, wages, working conditions or other matters Threats of harm to or physical restraint to any person if they fail to perform a certain act Prostitution, promotion of prostitution, aggravated promotion of prostitution, or compelling prostitution Texas Penal Code chapter 20A (trafficking of persons). Adapted from: Idaho State Department of Education Human Trafficking: Protecting Idaho’s Youth, PowerPoint Slide 4 and 5. Retrieved June 20, 2014, from

Sex Trafficking Under Texas Law: Children
Child sex trafficking occurs when a person: ACTION: Knowingly traffics a child under the age of 18 MEANS: Causes by any means PURPOSE: That the child engage in or become the victim of commercial sex acts or child sex abuse Traffics Force, Fraud, Coercion Commercial Sex Acts or Child Sex Abuse Transports, entices, recruits, harbors, provides, obtains, or maintains. NOT REQUIRED for child under 18 Commercial Sex Acts: Prostitution, promotion of prostitution, aggravated promotion of prostitution, or compelling prostitution Child Sex Abuse: Sexual assault, continuous sexual abuse of a young child or children, aggravated sexual assault, sexual performance by a child, employment harmful to children, indecency with a child, or possession or promotion of child pornography Texas Penal Code chapter 20A (trafficking of persons). Adapted from: Idaho State Department of Education Human Trafficking: Protecting Idaho’s Youth, PowerPoint Slide 4 and 5. Retrieved June 20, 2014, from

Trafficking Conditions: Adults and Children
Traffickers show little regard for a victim’s health or well-being. Victims may be subjected to inhumane conditions: Long work hours for little or no pay Live where they work, usually in very squalid conditions Subjected to verbal, physical, and sexual abuse Lack basic necessities and have limited access to medical care Polaris. No Date. “Child Labor Trafficking At-A-Glance.” Retrieved November 2, 2015, from National Human Trafficking Resource Center. Recognizing the Signs. Retrieved on October 19, 2015, from

Trafficking Conditions: Children
Force, fraud, or coercion is not required for sex trafficking victims under 18 years old. To be a victim of sex trafficking, a child under age 18 does not have to be: Deceived Manipulated Threatened Physically harmed Controlled Forced or coerced in any manner Texas Penal Code chapter 20A (trafficking of persons). Photo: National Crime Prevention Council. Resources. “In the Corner.” Retrieved July 15, 2014, from

Objective Understand risk factors and vulnerabilities related to human trafficking 32 percent complete

Risk and Exploitation While anyone can become a victim of human trafficking, several risk factors leave children and adults vulnerable to exploitation by traffickers. Risk factors typically fall into 1 of 4 categories: Individual Relationship Community Societal

Individual Factors that Increase Risk
Risk Factors for All Victims Child Specific Risk Factors In a new unfamiliar country or location History of child abuse, neglect, or exploitation Substance abuse Runaway or foster care Stigma and discrimination Adolescent development Disability Truancy & delinquency Mental illness/mental health Homelessness Low self-esteem Poverty or limited resources Language barriers Distrust of authority Adapted from: United States Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. August Human Trafficking Into and Within the United States: A Review of the Literature. Heather J. Clawson, Amy Solomon, and Lisa Goldblatt Grace, p Retrieved June 20, 2014, from California Child Welfare Council. February Ending the Commercial Sexual Exploitation of Our Children: A Call for Multi-System Collaboration in California, p Retrieved June 25, 2014, from Institute of Medicine and National Research Council of the National Academies. Confronting Commercial Sexual Exploitation and Sex Trafficking of Minors in the United States, p Retrieved June 26, 2014, from Polaris. No Date. “The Victims.” Retrieved July 9, 2014, Polaris Educators and Human Trafficking: In-Depth Review, p. 4. Retrieved July 9, 2014, from

Relationship Factors that Increase Risk
Risk Factors for All Victims Child Specific Risk Factors Unhealthy social relationships Peer pressure to engage in risky behavior Social isolation Family conflict, disruption, or dysfunction Lack of long-term connections or sense of belonging Family and friends living elsewhere Self-esteem not supported Gang affiliation Adapted from: United States Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. August Human Trafficking Into and Within the United States: A Review of the Literature. Heather J. Clawson, Amy Solomon, and Lisa Goldblatt Grace, p Retrieved June 20, 2014, from California Child Welfare Council. February Ending the Commercial Sexual Exploitation of Our Children: A Call for Multi-System Collaboration in California, p Retrieved June 25, 2014, from Institute of Medicine and National Research Council of the National Academies. Confronting Commercial Sexual Exploitation and Sex Trafficking of Minors in the United States, p Retrieved June 26, 2014, from Polaris Educators and Human Trafficking: In-Depth Review, p. 4. Retrieved July 9, 2014, from

Community Factors that Increase Risk
Risk Factors for All Victims Child Specific Risk Factors Reluctance to believe trafficking occurs in the community Limited community resources to assist at-risk youth populations No clear understanding of human trafficking No dedicated resources to identify victims or provide services Gang presence Lack of training and ongoing technical assistance Adapted from: United States Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation Identifying Victims of Human Trafficking: Inherent Challenges and Promising Strategies from the Field. Heather J. Clawson and Nicole Dutch, p. Pg Retrieved July 9, 2014, from Institute of Medicine and National Research Council of the National Academies. Confronting Commercial Sexual Exploitation and Sex Trafficking of Minors in the United States, p Retrieved June 26, 2014, from Polaris. No Date. “Myths and Misconceptions.” Retrieved July 9, 2014, from Shared Hope International. Taryn. March 28, “Gang Sex Trafficking on the Rise.” Retrieved July 9, 2014, from Houston Chronicle. Brian Rogers. June 11, “Alleged Pimp Behind Bars, but Feared in North Shore.” Retrieved July 9, 2014, from Texas Department of Public Safety. April Texas Gang Threat Assessment, p. 29. Retrieved July 9, 2014, from

Societal Factors that Increase Risk
Risk Factors for All Victims Child Specific Risk Factors Biases against human trafficking victims Apathy toward homeless and runaway youth Stigmas against prostitution Prevalence of sexual violence Racism/racial inequality Glamorization of pimp culture Individuals viewed as property or commodities Social norms Adapted from: Institute of Medicine and National Research Council of the National Academies. Confronting Commercial Sexual Exploitation and Sex Trafficking of Minors in the United States, p Retrieved June 26, 2014, from Polaris Educators and Human Trafficking: In-Depth Review, p. 4. Retrieved July 9, 2014, from

Objective Understand child trafficking 39 percent complete

-U.S. Department of Health and Human Services
Children at Risk “Among the diverse populations affected by human trafficking, children are at particular risk to sex trafficking and labor trafficking.” -U.S. Department of Health and Human Services United States Department of Health and Human Services, Administration for Children, Youth and Families. September Guidance to States and Services on Addressing Human Trafficking of Children and Youth in the United States, p. 1. Retrieved July 2, 2014, from

Physical or sexual abuse Homelessness or running away
Targeting the Most Vulnerable “Traffickers often prey on people who are hoping for a better life, lack employment opportunities, have an unstable home life, or have a history of sexual abuse.” -Polaris Physical or sexual abuse 66,572 confirmed victims of child abuse/neglect in FY 2014 Homelessness or running away 94,624 homeless students enrolled in Texas schools in 7,472 juvenile runaways taken into custody in FY 2014 Being in foster care 31,176 children in foster care in FY 2014 Of the children reported missing to NCMEC in 2014 who were also likely victims of sex trafficking, 68% were in the care of social services or foster care when they ran. -NCMEC (2014 data) Polaris Project. No Date. “The Victims.” Retrieved July 14, 2014, from National Center for Missing and Exploited Children. “Child Sex Trafficking.” Retrieved on November 17, 2015, from United States Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. August Human Trafficking Into and Within the United States: A Review of the Literature. Heather J. Clawson, Amy Solomon, and Lisa Goldblatt Grace, p.11. Retrieved June 20, 2014, from See also: Institute of Medicine and National Research Council of the National Academies. Confronting Commercial Sexual Exploitation and Sex Trafficking of Minors in the United States, p Retrieved June 26, 2014, from United States Department of Health and Human Services, Administration for Children, Youth and Families. September Guidance to States and Services on Addressing Human Trafficking of Children and Youth in the United States, p Retrieved July 2, 2014, from Los Angeles Probation Department survey indicated that 59 percent of the 174 juveniles arrested on prostitution-related charges were in the foster care system and were often recruited by traffickers in group homes. California Child Welfare Council found that between percent of the victims of commercial sexual exploitation are or were formerly involved with child welfare. Department of Children and Families in Connecticut reported that 86 out of the 88 children identified as child sex trafficking victims had been involved with child welfare services in some manner. Georgetown Law School, Center on Poverty and Inequality. March 20, Blueprint: A Multidisciplinary Approach to Domestic Sex Trafficking of Girls. Rebecca Epstein and Peter Edelman, p. 4. Retrieved July 10, 2014, from Shared Hope International. May The National Report on Domestic Minor Sex Trafficking: America’s Prostituted Children. Linda Smith, Linda, Samantha Healy Vardaman, and Melissa A. Snow, p Retrieved June 10, 2014, from National Conference of State Legislatures. October 1, Homeless and Runaway Youth. Retrieved July 15, 2014, from National Conference of State Legislatures found that 46% of homeless/runaway reported previous physical abuse, 38% emotional abuse, and 17% sexual abuse by a household member. Consequences of life on the street listed as increased likelihood of exchanging sex for food, clothing or shelter. Homeless: National Center for Homeless Education. (March 2014). Education for Homeless Children and Youths Program: Data Collection Summary, p Retrieved July 28, 2014, from Running Away: Texas Department of Public Safety. Crime in Texas: The Texas Crime Report for 2014, Chapter 9, p Retrieved October 27, 2015, from Foster Care: Texas Department of Family and Protective Services DFPS 2014 Data Book, p Retrieved October 27,2015, from Abuse: Texas Department of Family and Protective Services DFPS 2014 Data Book, p Retrieved October 27, 2015, from Homeless and runaway youth are targeted because they often lack the skills and basic necessities to survive on their own. -U.S. Department of Health & Human Services

Human Trafficking as a Form of Abuse
Texas Family Code, Section , specifically includes human trafficking as a form of child abuse. Cases involving abuse or neglect at the hands of a traditional caregiver may be investigated by the Department of Family and Protective Services (DFPS). All other cases must be handled by a law enforcement agency. Mandatory reporting applies in cases of suspected child abuse. Child abuse and neglect Human trafficking of children Texas Family Code section (definitions). Texas Family Code section (referral of report by department or law enforcement).

Understanding Child Trafficking
Thousands of children in the U.S. are at risk of trafficking. Children have been trafficked throughout Texas. Average age a child is recruited or forced into prostitution: years old. By understanding the dynamics of child trafficking, clinic staff will be better able to identify suspected instances of human trafficking and report as required. Dr. Robert David Sanborn and Dawn Lew. November “Fighting Human Trafficking in Texas,” Texas Bar Journal Vol. 75, No. 10, p November Retrieved July 7, 2014, from See media reports listed in training. Research indicates the average age for girls is and the average age for boys is years old. United States Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. August Human Trafficking Into and Within the United States: A Review of the Literature. Heather J. Clawson, Amy Solomon, and Lisa Goldblatt Grace, p Retrieved June 20, 2014, from

Preying on Children Traffickers prey upon children because they are easier to manipulate and deceive. They often target children with vulnerabilities, including: Lack of family support Significant familial and school disruptions Parental alcohol or substance abuse Exposure to domestic violence Lack of supervision, care or basic necessities (food, clothing, and shelter) Physical or sexual abuse histories California Child Welfare Council. February Ending the Commercial Sexual Exploitation of Our Children: A Call for Multi-System Collaboration in California, p. 5, Retrieved June 25, 2014, from Adapted from: United States Department of Health and Human Services, Administration for Children and Families. No Date. Child Victims of Human Trafficking. Retrieved July 8, 2014, from Federal Bureau of Investigation. March 26, Michael T. Harpster, Acting Deputy Assistant Director, Criminal Investigative Division, Federal Bureau of Investigation. “Statement Before the Committee on the Judiciary Subcommittee on Crime, Terrorism, Homeland Security, and Investigations, U.S. House of Representatives.” At a hearing entitled “Innocence for Sale: Domestic Minor Sex Trafficking.” Retrieved July 8, 2014, from

Child Sex Trafficking Can occur through:
Online advertisements of children for sex Children working in sexually oriented businesses Producing, buying, selling, or trading child pornography Buying, selling, or trading of children for sexual exploitation for anything of value Fake child modeling agencies Children engaging in sex acts to acquire food, clothing, or shelter See Texas Penal Code chapter 20A (trafficking of persons). California Child Welfare Council. February Ending the Commercial Sexual Exploitation of Our Children: A Call for Multi-System Collaboration in California, p Retrieved June 25, 2014, from United States Department of Justice. No Date. Prostitution of Children. Retrieved July 8, 2014, from United States Attorney’s Office, Western District of Missouri. July 17, “KC Man Indicted for Child Sex Trafficking, Producing Child Porn.” Retrieved July 8, 2014, from United States Attorney’s Office, Minnesota. July 22, “Man Sentenced for Sex Trafficking of a Minor, Conspiring to Produce Child Pornography.” Retrieved July 8, 2014, from Shared Hope, International. May The National Report on Domestic Minor Sex Trafficking: America’s Prostituted Children, p. 5, Retrieved July 3, 2014, from Illinois Department of Human Services. No Date. Human Trafficking Victim Dynamics. Retrieved November 2, 2015, from See also: Washington Department of Commerce. No Date. What is Human Trafficking? Retrieved July 10, 2014, from Photo: United States Department of Homeland Security. Images and Videos. “HSI, Dallas PD Serve Warrants.” Retrieved July 2, 2014, from (Photo courtesy of HSI.)

Objective Understand recruitment 49 percent complete

The Strategy of Recruitment
Regardless of age, sex, or type of trafficking, victims are often recruited in similar ways. By understanding the methods of traffickers, we can better identify victims and prevent exploitation.

Trafficker Recruitment Methods
Pick recruitment location Identify and exploit vulnerabilities Assert and maintain control

Recruitment Opportunities
Places Internet Street Online job ads Foster homes and residential treatment centers Gaming or other electronic devices with internet capabilities Bus stops Texting apps Train/metro stops Computers/tablets/laptops Shopping centers Smartphones and cell phones Parks/playgrounds Social networks Shelters Concerts/sports/public events Court houses Schools Restaurants and bars Juvenile detention Polaris. Domestic Sex Trafficking: The Criminal Operations of the American Pimp. A Condensed Guide for Service Providers and Law Enforcement, p. 3. Retrieved July 11, 2014, from University of Southern California Annenberg Center on Communication Leadership & Policy. The Rise of Mobile and the Diffusion of Technology-Facilitated Trafficking, p. 8. Mark Latonero, Jennifer Musto, Zhaleh Boyd, Ev Boyle, Amber Bissel, Kari Gibson, and Joanne Kim. Retrieved June 20, 2014, from NCMEC (National Center for Missing & Exploited Children). March Commercial Sexual Exploitation of Children: A Fact Sheet. Retrieved July 11, 2014, from NetSmartz® Parents & Communities Presentation, PowerPoint slide 3. Retrieved July 16, 2014, from Georgetown Law School, Center on Poverty and Inequality. March 20, Blueprint: A Multidisciplinary Approach to Domestic Sex Trafficking of Girls. Rebecca Epstein and Peter Edelman, p. 4. Retrieved July 10, 2014, from Polaris Knocking at Your Door: Labor Trafficking on Traveling Sales Crews, p. 1. Retrieved on October 26, 2015, from *If a trafficker does not have access to a recruitment location, the trafficker may use other victims to serve as recruiters.

Traffickers and Technology
Technology allows traffickers to more easily: Make contact or stalk victims Groom and recruit victims Control victims Employ sexting or sextortion tactics Advertise and market victims Connect with potential buyers Complete transactions Move victims Maintain anonymity Distance the trafficker from the crime University of Southern California Annenberg Center on Communication Leadership & Policy. The Rise of Mobile and the Diffusion of Technology-Facilitated Trafficking, p. 8 and 10. Mark Latonero, Jennifer Musto, Zhaleh Boyd, Ev Boyle, Amber Bissel, Kari Gibson, and Joanne Kim. Retrieved June 20, 2014, from Georgetown Law School, Center on Poverty and Inequality. March 20, Blueprint: A Multidisciplinary Approach to Domestic Sex Trafficking of Girls. Rebecca Epstein and Peter Edelman, p. 4. Retrieved July 10, 2014, from See also: Huffington Post. Ryan Grenoble. Oct. 12, “Amanda Todd: Bullied Canadian Teen Commits Suicide After Prolonged Battle Online and In School.” Retrieved July 11, 2104, from Details the school bullying and suicide that took place after online predator convinced Amanda during 7th grade to send sexual images online and used the photos for extortion. ABC News. Susan Donaldson James. August 3, “Investigation Finds Alleged Phony Church DarkSide in Full Swing.” Retrieved July 11, 2014, from A sexually oriented club in Dallas marketed to teens online while it masqueraded as a church to avoid taxes.

Using Technology to Recruit Children
Technology has facilitated exploitation of children, specifically. 75% of 12- to 17-year-olds own cellphones 93% of 12- to 17-year-olds go online Technology can be used to “reach children anywhere, anytime” and traffickers use it to their advantage. PewResearch Internet Project. February 3, Social Media & Mobile Internet Use Among Teens and Young Adults. Amanda Lenhart, Kristen Purcell, Aaron Smith, and Kathryn Zickuhr, p. 4 and 7. Retrieved June 20, 2014,from PewResearch Internet Project. April 20, Teens and Mobile Phones. Amanda Lenhart, Rich Ling, Scott Campbell, and Kristen Purcell, p. 2. Retrieved June 20, 2014, from Polaris Educators and Human Trafficking: In-Depth Review, p. 6. Retrieved July 9, 2014, from Institute of Medicine and National Research Council of the National Academies. Confronting Commercial Sexual Exploitation and Sex Trafficking of Minors in the United States, p Retrieved June 26, 2014, from University of Southern California Annenberg Center on Communication Leadership & Policy. The Rise of Mobile and the Diffusion of Technology-Facilitated Trafficking, p. 8 and 10. Mark Latonero, Jennifer Musto, Zhaleh Boyd, Ev Boyle, Amber Bissel, Kari Gibson, and Joanne Kim. Retrieved June 20, 2014, from

Traffickers Exploit Vulnerabilities
Individuals from an abusive home life may fall prey to false love and affection provided by the trafficker. Individuals who are impoverished may believe in the trafficker’s promise of a better life. Children who have runaway or are living on the street may be taken in by the trafficker who provides food and shelter. Adults and children using online social networks may be lured by the trafficker as they strike up friendships. Traffickers also further exploit the vulnerabilities of individuals experiencing social isolation, drug addiction, or with a history of criminal behavior. Polaris Educators and Human Trafficking: In-Depth Review, p. 6. Retrieved July 9, 2014, from NCMEC (National Center for Missing & Exploited Children). March Commercial Sexual Exploitation of Children: A Fact Sheet. Retrieved July 11, 2014, from Neha A. Deshpande, and Nawal M. Nour “Sex Trafficking of Women and Girls”. Obstetrics & Gynecology. 6(1) e22-e27. Retrieved on October 19, 2015, from

Trafficker Tactics Provide false feelings of love and affection
Create a dependency on drugs or alcohol Isolate the victims from others Physically, sexually, or verbally abuse the victim Confine the victim Control access to food or shelter Place the victim in “debt” Exhaust victims with long work hours and quotas Threaten friends, family, or other victims Convince individuals that engaging in commercial sex or other forced labor is better than the life they have at home Adapted from: Polaris. Online Training. “Human Trafficking and Runaway and Homeless Youth,” PowerPoint Slide 36. Retrieved November 2, 2015, from Polaris Educators and Human Trafficking: In-Depth Review, p. 6. Retrieved July 9, 2014, from United States Department of Health and Human Services, Administration for Children, Youth and Families. September Guidance to States and Services on Addressing Human Trafficking of Children and Youth in the United States, p. 6. Retrieved July 2, 2014, from Institute of Medicine and National Research Council of the National Academies. Confronting Commercial Sexual Exploitation and Sex Trafficking of Minors in the United States, p. 89 and Retrieved June 26, 2014, from Huffington Post. Lois Lee. July 9, “Residential Programs for America’s Child Sex Trafficking Victims Secure or Non-Secure Facilities.” Retrieved July 3, 2014, from Polaris. Human Trafficking. Retrieved on October 26, 2015, from

Denying, Blaming, Minimizing
Power & Control Coercion, Threats Intimidation Emotional Abuse Isolation Denying, Blaming, Minimizing Sexual Abuse Physical Abuse Using Privilege Economic Abuse Polaris. Online Training. “Human Trafficking and Runaway and Homeless Youth,” PowerPoint Slide 36. Retrieved November 2, 2015, from Slide reprinted with permission from NHTRC and Polaris. See also, Leidholdt, Dorchen A. “Human Trafficking and Domestic Violence A Primer for Judges”. The Judges Journal. 52(1). Retrieved on October 26, 2015, from Sources: The National Human Trafficking Resource Center, Polaris

The Trafficking Machine
Medical personnel are well-positioned to break the machine by recognizing risk factors, noticing indicators, and reporting suspected trafficking. Traffickers control victims in many ways. Examples include using physical, sexual, and emotional abuse, threats of violence, destroying the victim’s self-worth, and denying basic necessities Traffickers recruit victims by exploiting risk factors through manipulating victims’ needs The presence of risk factors makes individuals vulnerable to traffickers Polaris Project Educators and Human Trafficking: In-Depth Review, p Retrieved July 9, 2014, from Texas Young Lawyers Association Video interview with Lawrence Feldman. Slavery Out of the Shadows, video minutes 13:09-13:34. Retrieved November 2, 2015, from The Trafficking Machine

Objective Understand human trafficking indicators in the clinical setting 64 percent complete

Victim Encounters with Medical Providers
Studies show that between 28% and 88% of victims visit a health care facility while being trafficked. Rarely are they identified as trafficking victims. In one study: 57% of victims had received treatment at some type of clinic 71% of victims report at least 1 pregnancy while being trafficked 21% reported 5 or more pregnancies Family Violence Prevention Fund. (2005). “Turning Pain into Power: Trafficking Survivors’ Perspectives on Early Intervention Strategies,” pg. 14. Retrieved on November 9, 2015, from Baldwin, Susie B., David P. Eisenman, Jennifer N. Sayles, Gery Ryan, and Kenneth S. Chuang. (2011). “Identification of Human Trafficking Victims in Health Care Settings,.” Los Angeles County Department of Public Health. 13(1): pg. 1. Retrieved on November 9, 2015, from and Lederer, Laura J., and Christopher A. Wetzel. (2014). “The Health Consequences of Sex Trafficking and Their Implications for Identifying Victims in Healthcare Facilities”. Annals of Health Law. 23(1): pg. 77. Retrieved on November 9, 2015, from Lederer, Laura J., and Christopher A. Wetzel. (2014). “The Health Consequences of Sex Trafficking and Their Implications for Identifying Victims in Healthcare Facilities”. Annals of Health Law. 23(1): pg. 72. Retrieved on November 9, 2015, from Lederer, Laura J., and Christopher A. Wetzel. (2014). “The Health Consequences of Sex Trafficking and Their Implications for Identifying Victims in Healthcare Facilities”. Annals of Health Law. 23(1): pg. 77. Retrieved on November 9, 2015, from

Why Don’t Victims Ask for Help?
Limited family/social support False promises of security, love, a better future Trauma bonding Language and social barriers/ unfamiliarity Normalization of sex for survival/abuse Juvenile arrest histories– treatment as a criminal Fear and distrust No personal ID or documents Confined or monitored Convinced they are criminals Threats of violence and reprisal against loved ones Shame, self blame, hopelessness, resignation Children and adults may not self-identify as a victim or ask for help due to: Polaris. Domestic Sex Trafficking: The Criminal Operations of the American Pimp. A Condensed Guide for Service Providers and Law Enforcement, p. 5. Retrieved July 11, 2014, from Polaris. Online Training. “Human Trafficking and Runaway and Homeless Youth,” PowerPoint Slide 37. Idaho State Department of Education Human Trafficking: Protecting Idaho’s Youth, PowerPoint Slide 37. Retrieved June 20, 2014, from Texas Young Lawyers Association. “Slavery Out of the Shadows: Spotlight on Human Trafficking,” p. 2. Retrieved November 2, 2015, from Polaris. Myths and Misconceptions. Retrieved on October 26, 2015, from Clawson, Heather J Study of HHS Programs Servicing Human Trafficking Victims: Final Report. U.S. Department of Health & Human Services, Office of the Assistant Secretary for Planning and Evaluation. Retrieved on October 26, 2015, from

What Should I Look For? No one indicator signals trafficking has occurred. However, during the initial patient consultation or as staff assist the patient, additional information may be discovered indicating the patient is a victim of human trafficking. Indicators may fall into 6 broad categories: Urgent health care needs Infectious diseases Sexual/reproductive history Mental health issues Patient interaction Other indicators

Urgent Health Care Needs
Malnutrition Anemia Dehydration Traumatic injuries to the brain Damage to reproductive system Drug or alcohol abuse or withdrawal Eating disorders Physical injuries at various stages of healing (bruises, broken bones, cuts, burns) Polaris “Identifying Victims of Human Trafficking, What to Look for During a Medical Exam/Consultation.” Retrieved on November 18, 2015, from U.S. Department of Health and Human Services. “Resources: Common Health Issues Seen In Victims of Human Trafficking.” Retrieved on November 18, 2015, from Alpert, Elaine J., Roy Ahn, Erin Albright, Genevieve Purcell, Thomas F. Burke, and Wendy Macias-Kostantopoulos. (2014). “Human Trafficking: Guidebook on Identification, Assessment, and Response in the Health Care Setting.” Massachusetts General Hospital and Massachusetts Medical Society, pg Retrieved on November 9, 2015, from Arizona State University, School of Social Work, Office of Sex Trafficking Intervention Research. “What You Need to Know: Sex Trafficking and Sexual Exploitation: A Training Tool for Mental Health Providers.” Retrieved on November 18, 2015, from Welch, Katherine and Gloria Halverson. Christian Medical & Dental Associations. “The Physical Health Consequences of Human Trafficking.” Retrieved on November 19, 2015, from Tricia Vowels. Texas Department of State Health Services, Health Service Region 1. “Recognizing Child Abuse & Human Sex Trafficking in your Practice.” PowerPoint presentation, slide 19.

Infectious Diseases Tuberculosis
Skin infections such as scabies, lice, bacterial and fungal infections HIV/AIDS – may include mother-to-child transmission STIs including Hepatitis B, HPV, Herpes, Syphilis, and N. gonorrhea Typhoid Polaris “Identifying Victims of Human Trafficking, What to Look for During a Medical Exam/Consultation.” Retrieved on November 18, 2015, from Welch, Katherine and Gloria Halverson. Christian Medical & Dental Associations. “The Physical Health Consequences of Human Trafficking,” slides Retrieved on November 19, 2015, from Alpert, Elaine J., Roy Ahn, Erin Albright, Genevieve Purcell, Thomas F. Burke, and Wendy Macias-Kostantopoulos. (2014). “Human Trafficking: Guidebook on Identification, Assessment, and Response in the Health Care Setting.” Massachusetts General Hospital and Massachusetts Medical Society, pg Retrieved on November 9, 2015, from Tricia Vowels. Texas Department of State Health Services, Health Service Region 1. “Recognizing Child Abuse & Human Sex Trafficking in your Practice.” PowerPoint presentation, slide 21.

Sexual/Reproductive History
Exposure to HIV and other STIs Fertility issues Genital trauma Pregnancy Complications from prior pregnancies Urinary Tract Infections Other gynecological diagnoses associated with sexual violence Young age with high number of sex partners U.S. Department of Health and Human Services, Administration for Children, Youth and Families. “Guidance to States and services on Addressing Human Trafficking of Children and Youth in the United States,” pg. 6 Retrieved on November 9, 2015, from Alpert, Elaine J., Roy Ahn, Erin Albright, Genevieve Purcell, Thomas F. Burke, and Wendy Macias-Kostantopoulos. (2014). “Human Trafficking: Guidebook on Identification, Assessment, and Response in the Health Care Setting.” Massachusetts General Hospital and Massachusetts Medical Society, pg Retrieved on November 9, 2015, from Tricia Vowels. Texas Department of State Health Services, Health Service Region 1. “Recognizing Child Abuse & Human Sex Trafficking in your Practice.” PowerPoint presentation, slide 20. *These issues are most likely to be seen in sex trafficking victims, but may also occur in labor trafficking victims who are sexually assaulted.

Mental Health Issues Trafficking victims may suffer from mental health issues stemming from their victimization, such as: Depression Acute anxiety, stress, paranoia PTSD Self-destructive behaviors Suicidal ideation Dissociative disorder Explosive outbursts Hyper-sexualization Eating disorders U.S. Department of Health & Human Services, Office of the Assistant Secretary for Planning and Evaluation. (2010). “Evidence-based Mental Health Treatment for Victims of Human Trafficking”. Williamson, Erin, Nichole M. Dutch, and Heather J. Clawson. Retrieved on November 9, 2015, from Welch, Katherine. Christian Medical & Dental Associations. “The Mental Health Consequences of Human Trafficking.” Retrieved on November 19, 2015, from Alpert, Elaine J., Roy Ahn, Erin Albright, Genevieve Purcell, Thomas F. Burke, and Wendy Macias-Kostantopoulos. (2014). “Human Trafficking: Guidebook on Identification, Assessment, and Response in the Health Care Setting.” Massachusetts General Hospital and Massachusetts Medical Society, pg. 16. Retrieved on November 9, 2015, from

Patient Interaction Many times, victims:
Have scripted answers or inconsistent stories Avoid eye contact Are not allowed to speak for themselves Are accompanied by another individual (the trafficker) who is providing answers to questions directed at the victim Person does not leave patient alone with staff, even during examination Have few or no personal possessions Do not control own money, ID, or other legal papers U.S. Department of Health & Human Services. “Identifying Victims of Human Trafficking: Fact Sheet.” Retrieved October 6, 2015, from Polaris. Domestic Sex Trafficking: The Criminal Operations of the American Pimp. A Condensed Guide for Service Providers and Law Enforcement, p Retrieved October 06,2015, from Polaris Project. No Date. “Potential Trafficking Indicators.” Retrieved July 11, 2014: Polaris Project Educators and Human Trafficking: In-Depth Review, p. 8. Retrieved July 9, 2014, from Polaris. “Recognizing the Signs.” Retrieved on October 6, 2015, from Polaris. Trauma-Informed Human Trafficking Screenings, slide 6. Retrieved on October 27, 2014, from

Other Indicators Several other indicators may also be identified when serving trafficking victims. Patient has branding tattoos such as “daddy” or bar code designs Patient reports being a runaway or homeless Patient has bald spots, rotting teeth, or other indicators of poor health Patient has large amounts of cash on hand Patient is dressed in inappropriate or revealing clothing Polaris. “Recognizing the Signs.” Retrieved on October 6, 2015, from Polaris. Trauma-Informed Human Trafficking Screenings, slide 6. Retrieved on October 27, 2014, from Polaris. Domestic Sex Trafficking: The Criminal Operations of the American Pimp. A Condensed Guide for Service Providers and Law Enforcement, p Retrieved July 11, 2014, from Polaris. Identifying Victims of Human Trafficking: What to Look for During a Medical Exam/Consultation. Retrieved on November 10, 2015, from Texas Alcoholic Beverage Commission. For Signs of Human Trafficking, Look Beneath the Surface. Retrieved on November 10, 2015, from See also: Polaris Project Educators and Human Trafficking: In-Depth Review, p Retrieved July 9, 2014, from

Tattoo Examples First Photo RGJ.com. July 28, “Editorial: How to curb sex trafficking: make johns’ names public.” Retrieved July 11, 2014, from Photo used with permission from Reno Police Department. Second Photo KPBS. Amita Sharma. January 27, “Sex Trafficking Overtakes Drugs as San Diego County Gang’s Top Cash Source.” Retrieved July 11, 2014, from Photo used with permission from Amita Sharma. Branding tattoo found on a woman involved in a Reno-based sex trafficking ring. (Source: Reno Police Department) A sex trafficking victim shows her tattooed lip with the name of her pimp. (Source: Amita Sharma, KPBS)

Objective Understand how to respond to victims of trafficking and report as appropriate 79 percent complete

What Do I Do If I Suspect Human Trafficking?
Utilize appropriate screening tools Use trauma-informed care approach with patient Separate patient from individuals accompanying them This is for safety reasons and to allow the patient to answer questions more freely Ask questions and assess the situation Report to appropriate authorities Mandated reporting of child victims to DFPS (if the perpetrator is a household or family member) or local law enforcement Incidents of adult trafficking should be reported to local law enforcement, the Department of Family and Protective Services, or the Department of Public Safety ( Refer patient to community resources

Know Your Reporting Duties: Children
Under Texas law: All individuals are required to report suspected child abuse or neglect. Employees, volunteers and contractors of a facility licensed by the state, are required to report suspected child abuse or neglect immediately, but no later than within 48 hours. Your report cannot be delegated to a superior, administrator, or other individual. Reports must be made immediately to: Law enforcement, or the Department of Family and Protective Services (DFPS) DFPS may investigate certain reports and will refer other criminal matters to the appropriate law enforcement Texas Family Code, Section (Persons Required to Report; Time to Report). Texas Family Code, Section (Report Made to Appropriate Agency). *Failure to reported suspected child abuse or neglect is a criminal offense.

Reporting Suspected Human Trafficking if Victim is a Child (under 18 years old)
If an immediate danger, call 911. Follow reporting law and call law enforcement or Department of Family and Protective Services (DFPS). Contact DFPS by phone: , or online: Contact or use the TEXAS DPS app on your smart phone (operated by Texas Department of Public Safety which has human trafficking analysts on staff). Anonymous reports can be made to Provide tips or leads on suspected child sexual exploitation crimes to CyberTipline® at or THE-LOST ( ). 1 2 3 United States Department of Education, Office of Elementary and Secondary Education. No Date. Human Trafficking of Children in the United States: A Fact Sheet for Schools, p.2. Retrieved June 10, 2014, from Texas Family Code, Section (Persons Required to Report; Time to Report). Texas Family Code, Section (Report Made to Appropriate Agency). 4 *Failure to reported suspected child abuse or neglect is a criminal offense.

What to do if a Child Makes an Outcry
1. Make sure you and the victim are safe. 2. Remain calm. 3. Assure the child he or she did the right thing in telling you and that he or she is not to blame for the abuse. 4. Do not make promises about what will happen to them or the trafficker. 5. Let the child tell his or her story, but leave the questioning to the professionals. 6. Never confront the suspected trafficker. 7. Report. Texas law requires reporting to law enforcement or child protective services immediately, but no later than within 48 hours. Adapted from: Children’s Advocacy Center of Texas, Inc. No Date. Take Action: Educators. Courage to Report. Courage to Heal. Retrieved July 30, 2014, from Texas Family Code, Section (Persons Required to Report; Time to Report). Texas Family Code, Section (Report Made to Appropriate Agency).

Know Your Reporting Duties: Adults
Under Texas law: Adults have the right to not have their victimization reported to law enforcement. Exceptions are: Individuals over 65 years of age, or Individuals with a disability that substantially impairs him or her. All individuals, including medical practitioners, are required to report suspected abuse, neglect, or exploitation of elderly or disabled persons. Reports must be made immediately to: The state agency, that operates, licenses, certifies, or registers the facility, or the Department of Family and Protective Services (DFPS) DFPS may investigate certain reports and will refer other criminal matters to the appropriate law enforcement Human Resources Code, Section (Report).

Ways to Report Adult Victims
If in immediate danger, call 911. If unsure where to report, contact local law enforcement. Contact or use the TEXAS DPS app on your smartphone (analysts on staff). Anonymous reports can be made to ( ). Anyone who thinks an adult with disabilities or over 65 years of age is being trafficked should contact the Texas Abuse Hotline ( ) or make an online report at

Objective Take next steps 88 percent complete

Develop a Response Protocol
Adopt patient assessment and other screening tools specifically related to human trafficking Develop safety protocols and patient separation procedures Develop reporting procedures Understand how HIPAA applies to reporting incidents of human trafficking Know what local resources are available ahead of time

Ways You Can Help Recognize
Cases of trafficking occur in all types of environments. Understand what human trafficking looks like. Know high-risk groups and indicators. Identify and Report Interactions with at-risk populations serve as windows of opportunity to identify victims. Use existing facility safety policy and procedures for victims. Notify law enforcement and the Department of Family Protective Services. Share Share your knowledge with other professionals and community members. Educate others on human trafficking, high-risk groups and indicators. Engage Get to know resources. Join community organizations and task forces. If there is a gap in resources, establish partnerships to address the gaps.

Recognizing Exploitation
Recognize that traffickers, recruiters, and victims cross ethnic, racial, gender, socioeconomic, and age lines. Understand victims may not self-identify as victims. Recognize that traffickers brutalize their victims. Understand Texas residents are being exploited. REPORT what you observe to the proper authorities. National Human Trafficking Resource Center. Myths & Misconceptions. Retrieved on October 19, 2015, from

Recognizing Child Exploitation
Recognize that all kids are at risk of exploitation. Understand a child under 18 cannot consent to commercial sex. There is no such thing as a “good kid” or a “bad kid” when it comes to exploitation. Understand our children are being exploited. REPORT what you observe to the proper authorities. Adapted From: Polaris Project Educators and Human Trafficking: In-Depth Review, p Retrieved July 9, 2014, from National Human Trafficking Resource Center. Myths & Misconceptions. Retrieved on October 19, 2015, from

YOU Can be the Missing Link
When individuals report potential trafficking, victims can be linked to vital services, including: Counseling or mental health services Medical care Shelter or housing Immigration or legal services Safety planning Education and training Adapted from: Institute of Medicine and National Research Council of the National Academies. Confronting Commercial Sexual Exploitation and Sex Trafficking of Minors in the United States, p. 6. Retrieved June 26, 2014, from Polaris. Domestic Sex Trafficking: The Criminal Operations of the American Pimp. A Condensed Guide for Service Providers and Law Enforcement, p. 7. Retrieved July 11, 2014, from

Resources Potential Screening tools
Below are resources to help identify and serve victims of trafficking. The list is not meant to be exhaustive, and your facility may have other preferred tools, resources, or protocols that would apply to incidents of human trafficking Potential Screening tools Screening for Human Trafficking: Guidelines for Administering the Trafficking Victim Identification Tool (TVIT). (June 2014). VERA Institute of Justice. Retrieved from Polaris. Medical Assessment Tool. Retrieved from Alpert, E.J, et al. Human Trafficking: Guidebook on Identification, Assessment, and Response in the Health Care Setting. Massachusetts General Hospital and Massachusetts Medical Society. Retrieved from

Resources Trauma-informed care
Office for Victims of Crime, Training and Technical Assistance Center. Using a Trauma-Informed Approach. Retrieved from National Human Trafficking Resource Center. Trauma-informed Care and FYSB Outcomes for Runaway and Homeless Youth. Retrieved from Welch, Katherine, and Gloria Halverson. Christian Medical & Dental Associations. “Physical Health Consequences of Human Trafficking”.

Resources Other resources
Isaac, Reena, Jennifer Solak, and Angelo P. Giardino “Health Care Providers’ Training Needs Related to Human Trafficking: Maximizing the Opportunity to Effectively Screen and Intervene.” Journal of Applied Research on Children. Vol. 2(1). Article 8. Christian Medical & Dental Associations. “Human Trafficking Continuing Education.”

National Human Trafficking Resource Center
You may also contact the National Human Trafficking Resource Center ( ) to get additional information: Provide confidential tips. Connect with anti-trafficking services. Request training and technical assistance, general information, or specific anti-trafficking resources. Polaris. National Human Trafficking Resource Center. Found at

An Introduction to Human Trafficking

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