Title: Identifying Human Trafficking Victims in the Emergency Room: An Evaluation of an Identification Protocol Pilot Project for Front-Line Healthcare Providers Authors: Arduizur Carli Richie-Zavaleta, DrPH, MASP, MAIPS 1 ; Teresita Hinnegan, MMS 2 ; Nora Kramer, MSN, RN 3 ; Anh Hua, MPA 4 ; Anand Petigara, MSW 4 , Jeffrey Turner, MPH 5 ; Stephan McDonald, MSN, RN 6 , & Joseph Anton 6 Institutions: 1. Drexel University Dornsife School of Public Health & the University of New England Online College of Graduate and Professional Studies 2. Center for the Empowerment of Women 3. Thomas Jefferson University Hospital Department of Nursing 4. Nationalities Service Center 5. Public Health Management Corporation Research 6. Thomas Jefferson University Hospital Emergency Department Contacts: (Protocol) Anh Hua email: ahua@nscphila.org (Other inquiries) A. Carli Richie-Zavaleta arichiezavaleta@une.edu Abstract: Human Trafficking (HT) is defined as Modern Day Slavery. In the United States (US), HT is manifested mainly through sex and labor trafficking. Most sex trafficking victims are primarily US-natives and females. Although HT is a hidden crime, its victims at times seek medical care. However, many are unidentified due to a lack of training and identification protocols within healthcare settings. Literature on training of and identification-protocols for use by healthcare providers (HCP) are scant. Therefore, this pilot project evaluation aimed to assess providers’ confidence levels after attaining training on different areas of HT, and usefulness of an identification-protocol designed to facilitate victim detection and referral. This pilot-project was implemented at Thomas Jefferson University Hospital in Philadelphia, PA, among Emergency Department front-line personnel between January-August, 2016. Its evaluation used a single-group semi-time series design (0 X 0 0) as well as mixed-methods. Pre and post-tests were imparted at the initial time of training (N=12), followed by a post-test at 3- months (N=9). Analysis for quantitative data used a Paired Sample T-Test with a P < .05. Semi- structured interviews followed post-test assessment (N=3) and were analyzed using a thematic approach. Triangulation of data was accomplished by comparing QUAN and QUAL data sets and member checking during preliminary data findings.
This pilot project’s findings suggest: 1) Increased confidence levels among healthcare providers trained in different areas related to HT; 2) Reliance on tools designed to screen, assess, and refer potential HT victims; and 3) Improved HCP efficacy when using the noted protocol. Training and screening protocols are essential in order to identify HT victims in healthcare settings. More multi-site time-series evaluation designs on trainings and identification-protocols are therefore needed. Terms and Definitions: 1. Front-Line Personnel: These are the healthcare providers who are ultimately responsible to guide the potential victim through the established human trafficking protocols. They can be a frontline staff or any other health care provider. They are the most critical staff for the recommended protocol to be successful. 2. Front-Line Healthcare Personnel Trafficking In Person Protocol (FLHP-TIP): It is an identification protocol intended to assist healthcare providers and front-line personnel to identify, assist and refer victims of HT at any given healthcare setting. 3. Human Trafficking (HT): It is defined by the recruitment, harboring, transportation, provision or obtaining of a person for the purposes of commercial sex act, labor or services, through the use of force, fraud, or coercion. 4. Philadelphia Anti-Trafficking Coalition (PATC): An affiliation of social service, government, and law enforcement agencies dedicated to combating the issue of human trafficking in the Philadelphia area. 5. Point of Entry: It is any healthcare setting where injured or sick persons go to receive health and/or urgent care. They are the following: Hospital Emergency Room, Freestanding Clinic/Center, Urgent Care Centers and Municipal, State or Federal Health Clinics, Mental Clinics or Hospitals or Pharmacies. 6. Point-Person: The key trained personnel within the healthcare setting who posses a more in- depth understanding, confidence and skills of how to identify, assist and refer a victim of Human Trafficking. He or she is the “to-go” person during any given shift when any other staff or healthcare provider identifies potential red flags or human trafficking victimization in a patient. Richie-Zavlaeta, et al., 2
Aims : This pilot project’s evaluation aimed to understand: 1. Confident levels of participants after undergoing its training on different areas of HT 2. Identify usefulness of the identification-protocol to identify and refer HT victims. 3. Gathered recommendations to improve the training and identification protocol. Purposes of the Evaluation: PATC members developed the FLHP-TIP Protocol steps based on personal experiences working with trafficked victims and research and reports that have been published by other experts in the field. The team requested an evaluation of the pilot project to assess the impact of the protocol steps in helping healthcare staff in identifying potential victims of trafficking and to assess the effectiveness of the training for healthcare staff. The evaluation was carried out at Thomas Jefferson University Hospital’s Emergency Department, where the pilot project took place. The results of the evaluation would be used to provide recommendations for healthcare settings in developing human trafficking protocol and training for their staff. An MSW student at UPenn, an Evaluation Program Manager at PHMC, and a PhD in Public Health Candidate at Drexel University in consultation with the PATC members developed the evaluation. Due to constraint in funding, an independent evaluation was not obtained; the evaluation was implemented by those we were involved in the implementation of the pilot project. Evaluation Design & Methods: This evaluation design was based on mixed-methods approach. This type of design allows for greater comprehension of participants perspectives and context (Turner, Cardinal, & Burton, 2015). In this evaluation design, the evaluation team collected both types of data—qualitative and quantitative (Creswell, et al., 2004). This design also allows for triangulation of data as the two types of data increase understanding and confirmation of themes likely to emerge. This mixed-method design also allows for the potential emergence of different dimensions stemming from the evaluation objectives being pursued. The mixed-method design of this evaluation followed a Sequential QUANTITATIVE-qualitative (QUAN-qual) methodology with greater weight on the Quantitative data. Quantitative data informed qualitative instruments. The quantitative methodology included pre and post-training assessments at the initial time of in-depth 2 hour training implementation, followed by post-test at 3-months after implementation of training. It also included the creation of a protocol to identify and assess potential victims of HT at the ED. The training included the presentation and explanation of the protocol to participants of the ED. Some of the limitations of this evaluation design were the following: Richie-Zavlaeta, et al., 3
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