TJC: Abuse and human trafficking patients

The Joint Commission (TJC) is increasing its focus on the need to reach out to potentially traumatized patients. TJC posted two blog items this July, one on providing trauma informed care to patients who’ve been abused and the other on identifying human trafficking victims.

Both were written by Elizabeth Even, MSN, RN, CEN, the associate director of Clinical Standards Interpretation in the Division of Healthcare Improvement at The Joint Commission. Even has certifications in both emergency nursing (BCEN) and trauma nursing.

“A hospital or medical office can be terrifying for someone who has been abused,” she wrote. “The perceived power differential, being asked to remove clothing, and having invasive testing can remind someone of prior episodes of abuse.”

Trauma informed care is a way of thinking about the patient care process from the perspective of a victim. There are several barriers that could prevent a patient from speaking about their trauma—the captor could be in the room with them, they might not speak English, or they may have been threatened or coerced into silence.

“The time described above is not the time for medical jargon and long words,” she writes. “Rather, it is a time to slow down and try to understand what the patient is trying to tell you with or without words and to possibly coax more information out of them by making a connection. Skilled physicians and nurses can make the patient feel as though they are the only priority for even the briefest of encounters by making small efforts such as sitting down and making eye contact.”

Even suggests the following as best practices for dealing with potential abuse victims:

  • “Using the same words the patient is using and not correcting them, especially as it refers to their relationships and situation.”
  • “Being open to unfamiliar narratives/stories.”

 Human trafficking is one of the fastest growing criminal industries in America, and is worth several billion dollars. The practice can range from sex work to forced labor, and the number of reported trafficking cases have spiked in past years. However, confusion over what counts as trafficking vs. “traditional prostitution” can often blur the lines in the eyes of healthcare providers.

“There are many reasons why human trafficking may often be missed in health care encounters and the aforementioned misconceptions play a role,” she says. “Some staff hesitate to report because they believe the victims ‘have chosen this life’ or think the issue falls in the realm of social work or simply do not know what steps to take next or do not want to ‘cry wolf’ if they are unsure. Language barriers are often at play, as is poor staff training, availability as well as comfort levels.”

Studies say that 88% of all human trafficking victims receive medical treatment during their captivity. However, Even cites other studies showing that:

  • Providers only recognized sex trafficking 48% of the time.
  • Despite that, 75% think they’ve never encountered a human trafficking patient before.  
  • 63% have never been trained on identifying and treating human trafficking victims.

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