By KATHLEEN NELSON
Providing a safe haven for victims of human trafficking is vital to the mission of the Mercy Family Health Center and its Mercy Human Trafficking Clinic, both under the medical direction of Dr. Ron Chambers.
Chambers
The facilities are located on the campus of Dignity Health Methodist Hospital in Sacramento. That city is considered one of the hubs of human trafficking in California. The staff has developed training for residents and co-workers and created a series of best-practices guides, lists and procedures to identify and treat victims of human trafficking. Chambers outlined the care model and its resources in a recent CHA webinar.
Among the first pieces put in place was human trafficking training and education on topics of victim-centered, trauma-informed care for all residents and staff at Mercy Family Health Center, a primary care residency training clinic. Much of the training was based on SOAR, a program developed by the U.S. Department of Health and Human Services. SOAR's mnemonic outlines steps to identifying and treating victims of human trafficking:
- Stop to look for red flags in behavior.
- Observe signs of abuse during an exam.
- Ask the right questions, using a victim-centered, trauma-informed approach to create a sense of safety.
- Respond by identifying the victim's needs and having resources available.
"What trauma-informed care boils down to is empathy. It's what makes or breaks interaction with these patients," Chambers said. He added that victim-centered care requires a clinician to be sensitive and responsive to the patient's wishes in order to "maximize their input in all the decisions we're making. Let them know we're here to help when they're ready. That allows them to take control."
For example, each patient of the Mercy Human Trafficking Clinic is asked whether he or she prefers treatment from a male or female clinician. Surprisingly, Chambers said, fewer than 5 percent have had a preference. "In fact, some women request a male provider as they had worse things done to them by females they encountered," he said.
Chambers said the clinic treats female and male victims of both sex and labor trafficking, though sex trafficking victims account for about 80 percent of the victims. Because many victims of trafficking seek treatment only to return to the environment that led to the initial visit for medical care, he said the clinic's goal is "to become a one-stop shop," providing a continuum of services to the victim and his or her children.
The Mercy Human Trafficking Clinic is part of the Mercy Family Health Center. Out of sensitivity to the privacy of the clinic's patients, trafficking victims aren't made to wait in the center's general waiting room. Patients have longer appointments in the Mercy Human Trafficking Clinic, so there is time to talk not only with the resident physician but also with staff and social workers, who can connect them to community services.
"We'll treat a dental infection or an STD, but I think the biggest thing we do is treat the post-traumatic stress disorder, anxiety, the psychological needs of the victim. We want to get past flight-or-fight responses," Chambers said. "If we get her to a safe house, we'll use prazosin to take away the nightmares and a mood stabilizer so she can get a night's sleep. Then she can get one night, then two nights, then a week in the safe house and so on. In the meantime, the community agencies can provide all the wraparound care that she needs to get on the road to recovery."
In a follow-up interview, he shared details of the protocols that the clinic has developed, including a procedure list for caring for patients that any staff member suspects could be victims of human trafficking. The list includes recommended lab panels for pregnancy, sexually transmitted diseases, screening for drugs and tuberculosis; medications to treat anxiety, depression, post-traumatic stress, infectious diseases and STDs; as well as information on community resources.
With aid from Dignity's Human Trafficking Response initiative, the clinic also has published manuals and quick-reference guides with the goal of helping hospitals and clinics in other communities set up similar care models.
"What's impressive to me is that you couldn't look this up in a textbook," he said of the information. "We need to spread this model of care."
Chambers, director of the Dignity Health Methodist Family Medicine Residency Program, said, "In my medical training, I was taught to talk to my adolescent patients about automobile safety and suicide prevention. But trafficking is an issue that is far more likely to affect my patients' lives," Chambers said.
Almost 88 percent of trafficking victims interviewed across five cities by Abolition International in 2014 reported contact with a health care system. Yet none of the victims reported that a health care provider intervened or asked about trafficking.
"We are one of the few groups in society that see victims while they are being trafficked," Chambers said of health care providers. "Recognizing them is incredibly important because that's the first step in getting them out of their situation."
Chambers conducted his own research last year. Forty-two percent of residency program directors who responded to his survey said their residents see victims of human trafficking, yet only 14 percent said the residents receive training for identifying and treating victims of human trafficking.
"Most of us realize we've missed victims. That's frustrating, but we can get trained and educated," he said.
And someday, he hopes that the safe haven clinic concept can be replicated nationwide. As a first step, Dignity plans to incorporate human trafficking victim and survivor care training in eight primary care residency clinics in the next two years. Last year, the human trafficking clinic at Mercy Family Health provided services to about 120 human trafficking victims while training 21 residents.
"It's low-cost, widespread care that is easily replicable and works to educate our future physicians," Chambers said, noting that residents, "are going to go out and form their own practices. This will have a ripple effect. It isn't rocket science to see it's important to include human trafficking victim care in residency training. I think we're on our way."