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Human Trafficking Awareness for Rehabilitation Professionals

Original Editor - Stacy Schuirring

Top Contributors - Tarina van der Stockt, Stacy Schiurring and Kim Jackson  

Introduction

Rehabilitation professionals and healthcare workers are in the unique position to identify trafficked persons and provide assistance if that person is willing and in the position to accept help. To learn more about the types of human trafficking, and the legal considerations around the topic, please see this article.

This article will discuss how healthcare providers can identify, assess, and assist survivors of human trafficking.

The Impact of Human Trafficking on a Survivor

Survivors of human trafficking suffer physical, mental, emotional, and psychological injuries. Their independence and autonomy is taken from them. Their quality of life is hugely and devastatingly affected. A study by Hossain et al.[1] interviewed more than 200 survivors of sex trafficking and assessed for mental health and quality of life. They found 55% had high levels of depression symptoms, 48% had high levels of anxiety symptoms, and 77% were potentially suffering from Post-Traumatic Stress Disorder (PTSD).[1]

"Polyvictimization, also known as complex trauma, describes the experience of multiple victimizations of different types, such as sexual abuse, physical abuse, bullying, exposure to family violence, and more. This definition emphasizes different kinds of victimization, rather than just multiple episodes of the same kind of victimization, because it signals a generalized vulnerability. Research shows that the impact of polyvictimization is much more powerful than even multiple events of a single type of victimization." - National Children’s Advocacy Center[2]

Clinical Indicators of Human Trafficking

Within a clinical setting, healthcare professionals can come into contact with trafficked persons in any practice setting, including primary care settings, reproductive health clinics, medical specialities[3], or most commonly, emergency departments.[3][4]

Acute Injuries (Short Term / Immediate needs)

  • Fractures, burns or bruising,[4] [5]
  • Traumatic brain injuries or unexplained memory loss or signs of concussion[4]
  • Pattern injuries suggesting restraint (marks on wrists/ankles)
  • Facial/dental injuries including missing teeth
  • Complications from unsafe abortions[6]
  • Oral health problems[6]
  • Headaches[6]
  • Genital/rectal trauma / health concerns[6]
  • Anxiety, depression, suicidal ideation[6]
  • PTSD[6]
  • Somatic disorders[6]

Chronic Conditions (Longer Term Needs)

  • Reproductive/sexual health: frequent treatment of sexually transmitted infections or injuries, multiple unwanted pregnancies[4], lack of sexual desire or over-sexualised behaviours
  • Gastrointestinal problems, malnutrition[4] and dehydration[6]
  • Changes in sleep: sleeplessness, sleep disturbances, nightmares and/or night terrors, and/or insomnia, [7] sleep deprivation or psychosis[6]
  • Fatigue[7]disproportionate to reported activity level
  • Skin or respiratory problems caused by exposure to agricultural or other chemicals[4]
  • Communicable and non-communicable diseases[4]
  • Oral health issues, including broken teeth[4]
  • Chronic pain,[4] head/neck/spine injuries[6]
  • Fractures, burns, wound care[6]
  • Tattoos or branding of ownership[4][5]
  • Substance abuse-related health issues: abscess, HIV+, Chronic Venous Disorders, Sexually transmitted infections (STIs)

Behavioral/Psychological Indicators

  • Unable to concentrate or provide basic information including age, address or time[4]
  • Substance abuse[4]
  • Self-harm and suicidal ideation[7]
  • Depression, anxiety,[4] panic attacks[7]
  • Fear of being alone, distrust, and fear of strangers[7]
  • Guilt, shame, and/or self-blame[7]
  • PTSD[4][8]
  • Eating disorders[7]
  • Suspicious behaviour: appears nervous or avoids eye contact[4]; seems overly fearful, submissive, tense, or paranoid[5]
  • Has a lack of autonomy or independence. Person will defer to another before giving information[5], no control over identification documents[5]
  • Cultural, linguistic barriers and isolation[7]
  • Withholds information. The person can be unwilling to answer questions about their health, and gives confusing or contradicting information[4]

Optional reading: Red Flags of Labour Trafficking, Red Flags of Sex Trafficking, Human Trafficking Survivor Health Problems, United Nations Office on Drugs and Crime - Indicators of Trafficking in Persons, US Department of Homeland Security - Indicators of Human Trafficking.

Patient-Centred Care

Healthcare professionals can affect human trafficking with accurate identification of trafficked persons. Proper identification requires healthcare professionals to be familiar with vulnerabilities and clinical indicators/red flags of human trafficking that may be revealed during routine assessments, especially when taking a detailed social history. Few validated human trafficking screening tools exist for clinicians.[9] Available options are limited by lack of healthcare validation, long administration times, required expertise, and English-only availability.[10] See resources for downloads.

Patient-centred care is well-established as an essential element of high-quality patient care.[11] [12]It focuses on the partnership between patients and healthcare professionals to achieve increased patient satisfaction and improved outcomes.[13] Patient-centred care is achieved when clinicians actively engage patients in healthcare discussions and decision-making.[14]

Once a trafficking survivor has been identified in the clinical setting, the healthcare professional should interact with them in the following ways:

1) With respect for their autonomy

  • Use terms like "trafficked person" or "survivor" rather than "victim,"[15] but follow the individual's preferred language as many do not self-identify as trafficked.
  • Respect survivors as capable decision-makers [15]while recognising some may initially prefer limited choices during recovery.
  • Provide dignified healthcare including privacy, professional interpreters, and clear explanation of of the legal limitations of medical confidentiality due to mandatory reporting requirements.[15]

2) With nonmaleficence and beneficence

  • All healthcare professionals have an obligation to first do no harm (nonmaleficence) and to act in the best interests (beneficence) of our patients. Examples of positive interactions between patients and healthcare providers include (1) the removal of harm, (2) the prevention of harm, and (3) the promotion of good.[15]
  • The principle of nonmaleficence cautions against pressuring for a disclosure that they are being trafficked, especially in the presence of the trafficker. Aggressive attempts can be psychologically harmful to the trafficked person, and can potentially trigger intense stress, anxiety, fear, and retraumatising the individual.[15]
  • Respect the trafficked person's decisions about disclosure and accepting help, as they understand potential trafficker repercussions better than anyone. Honour their choices when mandatory reporting does not apply,[15] maintaining strict provider discretion throughout.

3) Considering justice

  • The unique circumstances surrounding the care of trafficked persons often challenge the concept of justice (the fair distribution of resources) by limiting trafficked persons’ ability to access appropriate and affordable health care outside of acute injuries and illnesses.[15]
  • Many healthcare professionals lack necessary training to recognise the signs and symptoms of human trafficking and meet survivors' complex needs.[15]
  • When making treatment decisions for conditions like communicable diseases or substance use disorders, providers must balance potential non-adherence against trafficker repercussions, sometimes requiring referrals to trusted organisations that can navigate these unique challenges.[15]

4) Considering how you interact

The following table lists provider strategies when interacting with a trafficked person.[16]

Physical posturing
  • Maintain open and accepting body language
  • Maintain relaxed body posture, neutral positions with hands at side, and be mindful to keep legs together
  • Ask permission to make physical contact every time, and explain the procedure before making contact
Attitudes
  • Do not stigmatise, victimise, or ask unrelated questions
  • Normalise the experience for the patient
  • Believe and validate the patient, confront any biases, and empathise
Language Provide empathetic and empowering statements:
  • “It is normal to feel this way”
  • “Thank you for sharing with me”
  • “You are very brave to tell me”
  • “I am so sorry that this happened to you. No one deserves that”

Use non-judgmental language such as “sex without a condom” vs “risky sex”

Use the term “survivor” vs “victim”

Encourage patient autonomy by saying “Is it okay if I?” instead of “I need to”

Ask “What is the most important thing you need right now?

The information in this table is modified from the Healthcare Provider Toolkit by REST.[16]

Optional: to learn more about interacting with suspected trafficked persons, please read this manual supported by the US Department of Justice.

Trauma-Informed Care

The trauma-informed approach to care is strongly recommended as a beneficial framework for caring for survivors of physical and psychological trauma, which includes persons who have experienced human trafficking. For these persons, effective care requires a sensitive, compassionate, measured approach with attention to healthcare practices to limit the triggering of fear, stress, shame, and stigmatisation.[15][8]

Trauma-informed care shares many principles with patient-centered care and is influenced by a healthcare provider's understanding of the impact of interpersonal violence and victimisation on an individual’s life and development.[8][17]

Examples include mindful sensitive wordage and proper verbal cues when requesting a patient disrobe for examination and assessment, and nonjudgement education on the use of contraception.

The US Department of Health and Human Services' Substance Abuse and Mental Health Services Administration defines a trauma-informed approach as one that:[15]

  1. Realises the widespread impact of trauma
  2. Recognises the signs and symptoms of trauma
  3. Responds by fully integrating knowledge about trauma into policies, procedures, and practices
  4. Seeks to actively resist re-traumatisation

Optional: to learn more about trauma-informed care, please read this link to The Healthcare Provider's Toolkit created by REST.

Making Use of Professional Medical Interpreters

When working with clients who don't share your language, always use professionally trained interpreters rather than relying on individuals who accompany the patient, as this can lead to biased or inaccurate translation. Seek interpreters specifically trained in trauma-informed care and human trafficking discussions. Remember that language ability alone doesn't guarantee cultural competency. Culturally appropriate translation builds trust and improves patient care. Follow your clinical setting's translation/interpreter protocol if one exists. Individuals in the USA can make use of the National Human Trafficking Hotline that provides translation services in over 200 languages. [18]

Benefits of using a professional medical interpreter include:

  • fewer communication errors
  • interpreter can act as a "cultural liaison" and provide clarification and context to the healthcare professional
  • interpreter can clarify patient meaning beyond language
  • interpreter can function as a link between a trafficked person and the healthcare system[19]

While there are times when a professional medical interpreter is not available and the use of an "ad hoc" interpreter such as a family member (including children) or friend are the only option. However, use of such an interpreter can lead to the following issues:[19]

  • non-professional interpreters may provide unsolicited advice or input
  • there is no guarantee of confidentiality around topics discussed
  • the medical professional may lose control of the interview due to off-topic conversations
  • scope of inquiry may be limited by embarrassment or discomfort around about intimate or sexual issues
  • unfamiliarity with medical terminology can lead to misunderstanding and errors in interpretation
  • children should not be used as interpreters except in emergencies due to limited understanding of adult issues

Challenges and Opportunities in Creating a Safe Healthcare Environment

Healthcare professionals also have a wider responsibility to their greater community. As specialised educators and advocates, healthcare professionals can collaborate with community and society-level stakeholders and lawmakers to help bring about change and support for trafficked persons. This can include:[9]

  • increasing awareness of human trafficking through healthcare facilities and community-level education programmes
  • advocating for local and national policies which promote community health and wellness
  • combating social or cultural norms that contribute to human trafficking
  • creating and maintaining an evidence-based guide and training programme to prevent future human trafficking
  • healthcare providers can impact human trafficking using a multi-level approach, advocating for change from bedside care to society level

In addition to building trust and rapport at an individual healthcare provider level, safety can also be enhanced at a facility and/or organisational level for survivors of human trafficking. Strategies to have private conversations can include:

Installation of a systemwide policy to see patients alone for at least a part of every visit. Examples of policy change can include: (1) posting signage that outlines this policy in plain view in common areas, (2) staff education, (3) completing assessments and interventions only when alone with the patient.[20]

Creation of a separation protocol to allow healthcare providers to examine or question the individual they believe is a trafficked person in a private, safe environment when there is suspicion that they are with a trafficker. The protocol should include: (1) who will carry out the physical separation process, (2) the steps to follow if the suspected trafficker refuses to comply, and (3) having a plan in place with hospital security and/or local law enforcement in case the trafficker becomes dangerous.[20]

The use of an ecological framework will provide the most holistic and wide-reaching response to human trafficking. The levels of responsibility within this framework include: [10]

  1. individual-level healthcare provider training
  2. health facility–level screening policies and response protocols
  3. community-level multidisciplinary resources and response teams
  4. society-level awareness campaigns, funding allocation, and data collection.

Operational Protocols for Safety

Establishing a trafficking response protocol tailored to your healthcare facility is essential for effective intervention. Your protocol should identify key implementation staff, assess internal and external resources, build partnerships with service agencies, define law enforcement engagement guidelines, distinguish between adult and child victim responses, provide educational materials, establish safety escort procedures, create discreet follow-up materials for at-risk patients, and set clear implementation timelines. Each facility's protocol will necessarily reflect its unique staffing and resource environment as well as the national/federal or regional laws applicable. [18]

To help you create a protocol, consider downloading the HEAL Protocol Toolkit as it is adaptable across emergency departments, hospitals, clinics, private practices, and school health centers. It will take you through all the steps needed to develop a protocol to respond to potential trafficked persons who present to your facility.

Best Practices for Documentation

Documentation of human trafficking by a healthcare professional of attempted and successful assessment, care and interventions provided, and referrals made. Examples of documentation include:

  • if human trafficking screening has/has not been completed. If screening has not occurred, document the reason why.[21]
  • if abuse, neglect, or other signs of trafficking are suspected, even if the patient denies these concerns. It is important to objectively document why trafficking is suspected.[21]
  • photographs with the patient's written and verbal consent. It is important to explain that the photographs will become part of their medical record, which is protected by HIPAA (Health Insurance Portability and Accountability Act) and any applicable state or local medical record privacy laws. If a situation arises where the medical record of the trafficked person is needed, legal counsel should be consulted to assist with the release of information.[21]
  • it is important to document that informed consent was obtained when working with adults and to contact local child protective services when working with a minor.[20]

Optional reading: please review this document by the University of Michigan Human Trafficking Collaborative for more information on healthcare documentation.

Best Practices for Survivor-Centred Multidisciplinary Referrals

Each survivor of human trafficking is unique and requires a different mix of services and support during their recovery journey. A strong multidisciplinary approach within the medical system and in community-based organisations and services will establish a safety net for safe return to the community. Building a comprehensive referral network will better meet the needs of survivors of human trafficking and their family members.[22]

A referral network should include interactions between:

Healthcare Provides collaboration with various healthcare professionals to identify and respond to human trafficking including:
  • short and long-term medical treatment
  • dental needs
  • sexual assault forensic examination
  • substance use treatment
  • malnutrition and/or dehydration treatment and education
Legal Aid
  • provide information regarding legal options and advocates
  • assistance with visa application
  • assistance with orders of protection
  • provide legal representation against their traffickers
  • assist with the documentation needed for eviction and housing issues
  • obtain proper legal documentation, such as proof of age and name at birth
  • assist expungement relief for trafficked persons with a criminal history as a result of their trafficking
  • provide family court services
Community-based Organisations Often are the leaders in the development of a protocol and serve as a primary referral for a variety of services:
  • housing
  • interpretation/translation services
  • childcare
  • vocational training
Social Services
  • access to benefits for those with incomes to include: cash, food, or energy assistance
  • childcare
  • Head Start programmes
  • child support offices
  • vocational assistance programmes for individuals with disabilities
Public Health Sector Can assist in preventing and identifying trafficking in a variety of ways, including:
  • health safety inspectors identifying potential indicators of trafficking in businesses or homes
  • community health workers monitoring the spread of disease and infection among at-risk populations
  • researchers identifying methods for preventing trafficking
  • incidence of trafficking and community surveillance
Law Enforcement
  • function as part of the criminal justice system
  • provide referrals to local service providers
  • creation of a human trafficking task force
  • provide certification to assist in applying for immigration relief
Behavioural Health Guide survivors to address trauma through:
  • counselling and therapy services
  • treatment for substance use
  • sexual assault trauma services
  • school-based counsellors
  • medication management
School-based services
  • school-based health centres
  • counselling and therapy services
  • Head Start programming
  • literacy programmes
  • mentoring programmes
  • childcare
  • parental support activities such as before/after school childcare, parenting classes, GED prep classes
  • accommodations for those struggling with school
  • free or reduced meal programmes
  • referrals to community resources
Connection to other survivors of human trafficking[23] Survivor engagement allows networks to better serve clients by providing mentorship, identifying challenges and opportunities, and achieving agency missions and mandates.

The information provided in this table was adapted from data given by the National Human Trafficking Training and Technical Assistance Center.[22]

Law Enforcement and Human Trafficking

Human trafficking is often underreported due to a lack of awareness of the crime. Trafficked persons are either unable or hesitant to come forward to law enforcement because of the control their trafficker has over their life. This control can include withholding of documents or identification, fear for themselves and for their family, or emotional or psychological manipulation. Trafficked persons may feel ashamed or fearful that they will be held legally accountable or potentially receive threat on their life (or the lives of their loved ones) for engaging with law enforcement. They may also fear deportation or other legal repercussions, such as losing their children or imprisonment, related to their circumstances.[24]

Traffic Survivors may feel ashamed and embarrassed about their situation or think that they are to blame for their circumstances. Trauma-coerced bonding, where the survivor forms an emotional attachment to their trafficker despite repeated abuse, can occur. This can prevent the survivor from wanting to leave their trafficker or report them to authorities.

Education, patience, and understanding are needed to help a trafficked person feel safe to disclose and report their situation to law enforcement.[24]

Law enforcement officers are often trafficking victims' first contact with authorities. The quality of this initial interaction can determine whether victims receive necessary support and whether traffickers face justice. Effective victim services directly enhance participation in criminal proceedings, which is essential for successful prosecution. This makes the first officer-victim encounter critically important.[24]

Optional reading: for more information on law enforcement's role in human trafficking, please read this report.

Adult and child protective services are not part of a law enforcement agency, rather they are social service programmes that investigate reports of abuse, neglect, or exploitation of these vulnerable populations. They can collaborate with law enforcement to include:[25][26]

  • conducting joint investigations
  • working together to serve warrants and protective orders
  • establishing points of contact and clear communication channels


To learn more about the role of Adult Protective Services, please read this handout. To learn more about Child Protective Services and how to report abuse or neglect in the State of Texas (USA), please view this link.

Mandatory Reporting Laws to Address Human Trafficking

All USA states and the District of Columbia mandate reporting of suspected or confirmed child abuse.[27] As of 2019, 43 states have mandatory reporting laws for elder abuse and neglect, with most providing legal protection for reporters. These laws, like child abuse statutes, include criminal penalties for non-compliance, though enforcement is rare.[27]

Usually these laws include (1) mandatory child abuse reporting laws, (2) domestic violence reporting laws, and (3) laws requiring reports of knife or gunshot wounds.[28]

Example: Texas Mandatory Reporting Law.

  • According to Texas Family Code Section  261.101: healthcare professionals are required to submit a report about suspected child abuse to law enforcement or the Department of Family and Protective Services (DFPS) within 48-hours of learning about the abuse. The duty of reporting the abuse cannot be delegated to another individual. Failure to do so is a criminal offense (Texas Family Code, Section 261.109).[29]
  • According to Texas Human Resources Code Section 48.051: anyone with knowledge about the suspected abuse of a person  65 or older or an adult with a disability must submit a report immediately to law enforcement or the DFPS.[30]

Other US States: Jones Day created a tool the reflect mandatory reporting laws federally and per state. The link to the updated tool is in this article.

Benefits of these laws: Healthcare professionals are incentivised to report human trafficking under these laws, which should increase the overall awareness of human trafficking and improve education and assessment skills within the healthcare community. These reports can initiate investigations that protect survivors and prosecute traffickers. Many states now have "safe harbor" laws treating trafficked individuals as survivors needing trauma-informed care rather than as criminals.[28]

Risks of these laws: Mandatory reporting laws can protect trafficking survivors but also create vulnerability risks due to their mistrust of authorities and fear of traffickers. These laws override normal healthcare confidentiality, potentially causing survivors to avoid medical care due to fears of trafficker retaliation, criminal prosecution, or deportation.[28]

To ensure the protection and safety of trafficked persons, healthcare and law enforcement professionals must be properly trained in human trafficking and their roles as part of a multidisciplinary team. Trafficked persons must have access to trauma-informed care, and support systems must have the necessary resources to provide meaningful prevention and protection. With measures in place to ensure that the risks of mandatory reporting laws are limited, healthcare professionals can assume the role of mandatory reporters of human trafficking while meeting their ethical obligations.[28]

Resources

North American Resources:

Texas, USA
Michigan, USA
Ontario, Canada

Clinical Tools and Resources:

Clinical Tools and Resources on Substance Use Challenges

References

  1. ↑ 1.0 1.1 Hossain M, Zimmerman C, Abas M, Light M, Watts C. The relationship of trauma to mental disorders among trafficked and sexually exploited girls and women. American journal of public health. 2010 Dec;100(12):2442-9.
  2. ↑ Office of Justice Programs. Mental Health Needs. Available from: https://www.ovcttac.gov/taskforceguide/eguide/4-supporting-victims/44-comprehensive-victim-services/mental-health-needs/#:~:text=The%20types%20of%20physical%20and,narcotics)%2C%20and%20eating%20disorders. (accessed 28/April/2023).
  3. ↑ 3.0 3.1 Polaris Project. Human Trafficking and the Health care Industry. Available from: https://polarisproject.org/human-trafficking-and-the-health-care-industry/#:~:text=Most%20trafficking%20victims%20will%20have,or%20most%20often%2C%20emergency%20departments.(accessed 26 June 2023).
  4. ↑ 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 4.11 4.12 4.13 4.14 4.15 Texas Health and Human Services. Texas Human Trafficking Resource Center. Available from: https://www.hhs.texas.gov/services/safety/texas-human-trafficking-resource-center (accessed 28/April/2023).
  5. ↑ 5.0 5.1 5.2 5.3 5.4 Attorney General of Texas. Red Flags for Sex Trafficking. Available from: https://www.texasattorneygeneral.gov/human-trafficking-section/signs-trafficking/red-flags-sex-trafficking (accessed 28/April/2023).
  6. ↑ 6.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.09 6.10 REST. Population-specific health needs. Available from: https://iwantrest.com/hcp-toolkit/population-specific-health-needs (accessed 14 June 2023).
  7. ↑ 7.0 7.1 7.2 7.3 7.4 7.5 7.6 7.7 Office of Justice Programs. Mental Health Needs. Available from: https://www.ovcttac.gov/taskforceguide/eguide/4-supporting-victims/44-comprehensive-victim-services/mental-health-needs/#:~:text=The%20types%20of%20physical%20and,narcotics)%2C%20and%20eating%20disorders. (accessed 28/April/2023).
  8. ↑ 8.0 8.1 8.2 Chambers R, Gibson M, Chaffin S, Takagi T, Nguyen N, Mears-Clark T. Trauma-coerced attachment and complex PTSD: informed care for survivors of human trafficking. Journal of Human Trafficking. 2022 Apr 18:1-0.
  9. ↑ 9.0 9.1 Greenbaum VJ, Titchen K, Walker-Descartes I, et al. Multi-level prevention of human trafficking: the role of health care professionals. Prev Med. 2018;114:164-167.
  10. ↑ 10.0 10.1 Munro-Kramer ML, Beck DC, Martin KE, Carr BA. Understanding health facility needs for human trafficking response in Michigan. Public Health Reports. 2022 Jul;137(1_suppl):102S-10S.
  11. ↑ World Health Organization.  Regional Office for Europe. Roadmap: strengthening people-centred health systems in the WHO European region: a framework for action towards coordinated/integrated health services delivery (CIHSD). Geneva: WHO; 2013.
  12. ↑ Havana T, Kuha S, Laukka E, Kanste O. Patients' experiences of patient-centred care in hospital setting: A systematic review of qualitative studies. Scand J Caring Sci. 2023 Dec;37(4):1001-1015.
  13. ↑ Delaney LJ. Patient-centred care as an approach to improving health care in Australia. Collegian. 2018;25(1):119-23.
  14. ↑ Wasim A, Sajan M, Majid U. Patient-centered care frameworks, models and approaches: An environmental scan. Patient Experience Journal. 2023; 10(2):14-22.
  15. ↑ 15.00 15.01 15.02 15.03 15.04 15.05 15.06 15.07 15.08 15.09 15.10 Macias-Konstantopoulos WL. Caring for the trafficked patient: ethical challenges and recommendations for health care professionals. AMA journal of ethics. 2017 Jan 1;19(1):80-90.
  16. ↑ 16.0 16.1 REST. Do’s and don’ts for taking a health history and conducting a physical exam for individuals in the sex trade. Available from: https://iwantrest.com/hcp-toolkit/dos-donts-for-an-exam (accessed 14 June 2023).
  17. ↑ REST. What is trauma-informed care?. Available from: https://iwantrest.com/hcp-toolkit/trauma-informed-care (accessed 14 June 2023).
  18. ↑ 18.0 18.1 Human Trafficking Toolkit for Healthcare Professionals by Baylor College of Medicine. United Against Human Trafficking.
  19. ↑ 19.0 19.1 Juckett G, Unger K. Appropriate use of medical interpreters. American family physician. 2014 Oct 1;90(7):476-80.
  20. ↑ 20.0 20.1 20.2 National Human Trafficking Training and Technical Assistance Center. Create and Maintain Safety. Available from: https://nhttac.acf.hhs.gov/soar/eguide/ask/Safety_is_Top_Priority (accessed 15 June 2023).
  21. ↑ 21.0 21.1 21.2 Human Trafficking Collaborative. Documentation. Available from: https://humantrafficking.umich.edu/templates/documentation/ (accessed 26 June 2023).
  22. ↑ 22.0 22.1 National Human Trafficking Training and Technical Assistance Center. Multidisciplinary Treatment and Referral Team. Available from: https://nhttac.acf.hhs.gov/soar/eguide/resources/Building_a_Referral_Network (accessed 15 June 2023).
  23. ↑ Lockyer S. Beyond inclusion: Survivor-leader voice in anti-human trafficking organizations. Journal of human trafficking. 2022 Apr 3;8(2):135-56.
  24. ↑ 24.0 24.1 24.2 Police Executive Research Forum. How Local Police Can Combat the Global Problem of Human Trafficking. Available from: https://www.policeforum.org/assets/CombatHumanTrafficking.pdf (accessed 26 June 2023).
  25. ↑ Texas Department of Family and Protective Services. APS Partners: Law Enforcement. Available from:https://www.dfps.texas.gov/Partnering_To_Protect/adult-protective-services-partners/law-enforcement/# (accessed 21 March 2025).
  26. ↑ Texas Department of Family and Protective Services. Child Protective Services (CPS). Available from:https://www.dfps.texas.gov/child_protection/ (accessed 21 March 2025).
  27. ↑ 27.0 27.1 Geiderman JM, Marco CA. Mandatory and permissive reporting laws: obligations, challenges, moral dilemmas, and opportunities. JACEP Open. 2020 Feb 1;1(1):38-45.
  28. ↑ 28.0 28.1 28.2 28.3 English A. Mandatory reporting of human trafficking: potential benefits and risks of harm.AMA journal of ethics. 2017 Jan 1;19(1):54-62.
  29. ↑ Texas Department of Family and Protective Services. When and How to Report Child Abuse. Available from: https://www.dfps.texas.gov/Child_Protection/Child_Safety/report_abuse.asp#:~:text=Professionals%20must%20make%20a%20report,Family%20Code%2C%20Section%20261.101).(accessed 07/September/2023).
  30. ↑ Texas Constitution and Statutes. INVESTIGATIONS AND PROTECTIVE SERVICES FOR ELDERLY PERSONS AND PERSONS WITH DISABILITIES. Available from: https://statutes.capitol.texas.gov/Docs/HR/htm/HR.48.htm (accessed 07/September/2023).
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