- Email: [email protected]
Identifying, treating, and advocating for human trafficking victims: A key role for psychiatric inpatient units
General Hospital Psychiatry 46 (2017) 41–43
Contents lists available at ScienceDirect
General Hospital Psychiatry journal homepage: http://www.ghpjournal.com
Editorial
Identifying, treating, and advocating for human trafficking victims: A key role for psychiatric inpatient units Keywords: Human trafficking Inpatient psychiatry Screening Identification Multidisciplinary
The United Nations defines human trafficking as the “recruitment, transfer, harbouring or receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability … for the purposes of exploitation” [1]. There is an estimated 45.8 million women, men, and children around the world that are victims of human trafficking. In the United States alone there are an estimated 58,000 individuals who have been coerced or forced into servitude [2]. Human trafficking remains a critical public health concern that is poorly understood, insufficiently taught [3], and under-researched, especially in the US. These factors may potentially contribute to a lack of understanding and awareness of human trafficking among healthcare professionals. Furthermore, there is a lack of validated screening tools for use in medical settings [4]. It may also explain why highly-skilled and wellintentioned health care providers unknowingly and perhaps sometimes insensitively interact with human trafficking victims [5]. It has been estimated that approximately 88% of human trafficking victims have interacted with a health care professional at some point in their life, although less than 20% of these individuals reported that their health care providers knew of their trafficking status [6]. To address a possible lack of awareness or insensitivity to human trafficking in psychiatry, one of us (JHC) had recently issued a call to action to teach about human trafficking in psychiatric settings [3]. Well-informed providers may find that they are ill-equipped or constrained by their treatment settings to effectively screen for and treat trafficking victims due to the complexity of the biopsychosocial issues with which these victims may present [7]. Educating staff and trainees about human trafficking should increase their vigilance and effectiveness in the identification of human trafficking victims. On our own inpatient unit we have noted a substantial increase in the number of patients that have screened positive for human trafficking given routine screening and improved awareness. A trauma-informed and patient-centered care model allows for a predictably safe, confidential and therapeutic treatment setting on a multidisciplinary unit. We suggest that psychiatric inpatient units can play key role in identifying, treating, and advocating for human trafficking victims due to their multidisciplinary and integrated care approach to addressing patients' biopsychosocial issues. We searched PubMed using the terms “human trafficking” and “inpatient psychiatry” and found no papers that explored the important role
http://dx.doi.org/10.1016/j.genhosppsych.2017.02.006 0163-8343/© 2017 Elsevier Inc. All rights reserved.
that acute psychiatric inpatient units could play in the identification and treatment of human trafficking victims. We then combined the search term “human trafficking” with the following terms in separate searches: cognitive impairment, counseling, chronic mental illness, risk factors, substance use, and vulnerability and found no papers that described human trafficking patients in North American psychiatric settings. There is some evidence from England that victims of human trafficking have a higher likelihood of being admitted to psychiatric inpatient units than non-trafficked patients [8]. This adds to the importance that this topic be addressed clinically, educationally, and empirically. Through our work on an acute psychiatric inpatient unit, we have learned that sex and labor trafficking patients come from extremely diverse backgrounds and can vary greatly in terms of age, gender, race, culture, immigration status, and socioeconomic background [9]. They also vary in the ways in which they have been victimized, and whether being currently or previously trafficked. There are factors that can increase an individual's vulnerability to trafficking. These include youth, a history of childhood abuse, homelessness, belonging to a sexual minority group (i.e. LGBTQ identified), cognitive or physical disability, being a migrant worker, having low socioeconomic status, and being a racial or ethnic minority [7,10]. Psychiatric inpatient units should expect to see these patients being admitted because many of the vulnerabilities that led to victimization are common to patients with major mental disorders. When working with trafficking victims, however, it is important to remember that any individual has the potential to have been a victim of human trafficking [11]. Thus, providers must maintain a constant state of vigilance for the relevant signs and symptoms. Rules of confidentiality can create much needed space between patients and their traffickers which in turn can increase the chances that suspected trafficking victims will be forthcoming and properly identified. There are many factors that may contribute to a lack of recognition of human trafficking victims in treatment settings. Patients are sometimes reluctant or ashamed to talk about personal and often painful past experiences [5]. Past negative experiences with providers [5], cultural mistrust of health care professionals, or fear of law enforcement/ immigration officials may transfer to treatment members and inhibit disclosure from victims [12,13]. Inpatient psychiatric units can provide additional opportunities for treatment team members to develop positive working alliances with suspected trafficking victims facilitating disclosure and the appropriate targeting of interventions and referrals. Inpatient units also provide an opportunity for patients to stabilize and to begin to process their experiences. Another primary reason that trafficked patients may not be identified is that their psychiatric conditions prevent them from accurately reporting their trafficking history and status. Patients may present as acutely psychotic, manic, agitated, or delirious. In an acute or decompensated status, patients may not be as reliable or forthcoming about
42
Editorial
their backgrounds or histories. We suggest, therefore, that providers maintain high vigilance for human trafficking beyond the initial assessment point and rescreen patients when the mental status improves. Additionally, we recognize that many health care providers may be reluctant to ask patients about possible trafficking experiences because of the potentially disturbing information that is disclosed. This discomfort on the part of providers may also contribute to the reluctance of human trafficking victims to identify themselves in health care settings [5,6]. Nevertheless, training health care providers to effectively identify human trafficking victims is both an ethical and moral imperative. Obtaining an accurate accounting of trafficking history can lead to more effective treatment plans, recommendations, and better overall outcomes and can reduce the potential for individuals becoming re-victimized. Psychiatric inpatient units may provide more time to carry out treatment interventions that can lead to a reduction in patients' vulnerability to being trafficked. Human trafficking victims benefit greatly when provided a safe, stable, and predictable environment, particularly because they have often been subjected to violence and are at elevated risk of physical and mental health problems [14,15]. Psychiatric inpatient units are a desirable treatment setting for human trafficking victims because of the relatively slower pace, good patient-to-provider ratio, and multidisciplinary nature of the biopsychosocial interventions. A patient-centered, trauma-informed, and multifaceted approach is essential for managing victims of human trafficking [7]. Thus, unit staff must work collaboratively to minimize victims' exposure to agitated or aggressive patients to decrease the potential that victims are re-traumatized. Providers at different levels of care and stages in training may interact with patients and provide them with safe spaces to talk about and process the details of their trafficking history. An integrated care approach will facilitate consultation with other medical, surgical and gynecological disciplines when indicated, and ensure that human trafficking victims have adequate access to quality healthcare, including substance abuse treatment options. Human trafficking victims may have very limited access to appropriate health care [16] and it is important to rectify any such barriers to treatment. Understanding a patient's trafficking history helps inform treatment and interventions which can help break the cycle of re-victimization. We assume that treatment of underlying psychiatric vulnerabilities can improve patients' mental status, but it can also help patients to make better use of available psychological and social service resources. Social work should be consulted to help patients minimize stressors by providing them access to a wide variety of services and resources. These resources include but are not limited to arranging alternate or transitional housing and connecting victims to vocational rehabilitation agencies, ID programs, food banks, clothing resources, and child/adult protective services. When possible, treatment team members should also try to liaise with local immigration and legal aid agencies to advocate for patients who are undocumented or have legal concerns because of their trafficking history. By its very nature human trafficking is a coercive interaction and victims are forced to do things that are detrimental to their physical and mental well-being. They may have to decide between their own safety and the safety of their loved-ones or have real fears of being deported or incarcerated because of activities that they were involved in during their time of enslavement. Many trafficking victims are forced into illegal activities by their traffickers which may result in criminal charges or outstanding warrants, thereby decreasing their sense of comfort in turning to law enforcement officials for help. With careful consideration of patient and staff safety, and with the understanding that providers can be subpoenaed by the courts, opportunities should also be provided to help trafficking victims make police reports or work with police to bring their traffickers to justice [17]. The psychiatry profession can help bring awareness to this critical public health matter by publishing the work that takes place in various psychiatric settings with human trafficking victims. There is a dearth of research that specifically examines how psychiatric factors can affect
patients' potential for being trafficked, especially here in the United States. Additionally, we should maintain a sense of vigilance and routinely screen (and rescreen) for trafficking victims as their conditions improve. We must work towards validating a human trafficking screen that can be used effectively with patients with psychiatric conditions. We should also keep in mind how different psychiatric conditions can complicate the identification of victims and hinder self-disclosure from patients. We remind readers that human trafficking victims do not fit into any one particular mold, despite much of the medical literature focused primarily on female sex-trafficking victims from low- and middle-income countries [18]. Biopsychosocial interventions implemented on acute psychiatric inpatient units can interrupt the cycle of victimization and re-victimization by addressing patients' multiple vulnerabilities, helping patients to access available resources, and assisting them with outpatient planning after discharge. Inpatient units are therefore an important locus of care for the management of trafficked victims. Mental health providers are uniquely positioned to identify, treat, and advocate on behalf of trafficking victims because of their training in biopsychosocial assessments and interventions. They can also help educate and train other health care providers and support staff to better identify signs and symptoms of human trafficking and to connect trafficking victims with various advocacy organizations and social service agencies in the community. We should do all we can to help victims make prudent decisions to not return to their traffickers and to assist them in beginning a pathway of recovery. Disclosure On behalf of all authors, the corresponding author states that there is no conflict of interest. References [1] United Nations Office on Drugs and Crime. United Nations convention against transnational organized crime and the protocols thereto [Available from: https://www. unodc.org/documents/treaties/UNTOC/Publications/TOC%20Convention/TOCebooke.pdf. Accessed December 19] ; 2016. [2] The Walk Free Foundation Ltd. The global slavery index; 2016 [Available from: https://www.globalslaveryindex.org. Accessed September 26, 2016]. [3] Coverdale J, Beresin EV, Louie AK, Balon R. Human trafficking and psychiatric education: a call to action. Acad Psychiatry 2016;40:119–23. [4] Bespalova N, Morgan J, Coverdale J. A pathway to freedom: an evaluation of screening tools for the identification of trafficking victims. Acad Psychiatry 2016;40:124–8. [5] Baldwin SB, Eisenman DP, Sayles JN, Ryan G, Chuang KS. Identification of human trafficking victims in health care settings. Health Hum Rights 2011;13:e36–49. [6] Lederer LJ, Wetzel CA. The health consequences of sex trafficking and their implications for identifying victims in health care facilities. Ann Health Law 2014;23:61–91. [7] Macias-Konstantopoulos W. Human trafficking; the role of medicine in interrupting the cycle of abuse and violence. Ann Intern Med 2016;165:582–8. [8] Borschmann R, Oram S, Kinner S, Dutta R, Zimmerman C, Howard L. Self-harm among adult victims of human trafficking who accessed secondary mental health services in England. Psychiatr Serv 2016 [Epub ahead of print]. [9] Turner-Moss E, Zimmerman C, Howard LM, Oram S. Labour exploitation and health: a case series of men and women seeking post-trafficking services. J Immigr Minor Health 2014;16:473–80. [10] The Passage. Understanding and responding to modern slavery within the homelessness sector. Report commissioned by the UK Independent Anti-Slavery Commissioner; 2017. [11] Kerr PL. Treating trauma in the context of human trafficking: intersections of psychological, social and cultural factors. In: Ghafoori B, Caspi Y, Smith S, editors. International Perspectives on Traumatic Stress; 2016. p. 199–221. [12] Benkert R, Peters R, Clark R. Effects of perceived racism, cultural mistrust and trust in providers on satisfaction with care. J Natl Med Assoc 2006;98:1532–40. [13] Rhodes S, Mann Li, Simán F, Song E, Alonzo J. The impact of local immigration enforcement policies on the health of immigrant Hispanics/Latinos in the United States. Am J Public Health 2015;105:329–37. [14] Oram S, Abas M, Bick D, et al. Human trafficking and health: a survey of male and female survivors in England. Am J Public Health 2016;106:1073–8. [15] Ottisova L, Hemmings S, Howard LM, Zimmerman C, Oram S. Prevalence and risk of violence and the mental, physical and sexual health problems associated with human trafficking: an updated systematic review. Epidemiol Psychiatr Sci 2016; 12:1–25 [Epub ahead of print]. [16] Zimmerman C, Hossain M, Watts C. Human trafficking and health: a conceptual model to inform policy, intervention and research. Soc Sci Med 2011;73:327–35.
Editorial [17] Gibbons P, Stoklosa H. Identification and treatment of human trafficking victims in the emergency department: a case report. J Emerg Med 2016;50:715–9. [18] Oram S, Stöckl H, Busza J, Howard LM, Zimmerman C. Prevalence and risk of violence and the physical, mental, and sexual health problems associated with human trafficking: systematic review. PLoS Med 2012;9:e1001224.
Phuong T. Nguyen* John H. Coverdale Mollie R. Gordon Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, Houston, TX, United States
43
⁎Corresponding author at: One Baylor Plaza, MS 350, Houston, TX 77030, United States. E-mail address: [email protected] (P.T. Nguyen). 20 February 2017 Available online xxxx
Contents lists available at ScienceDirect
General Hospital Psychiatry journal homepage: http://www.ghpjournal.com
Editorial
Identifying, treating, and advocating for human trafficking victims: A key role for psychiatric inpatient units Keywords: Human trafficking Inpatient psychiatry Screening Identification Multidisciplinary
The United Nations defines human trafficking as the “recruitment, transfer, harbouring or receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability … for the purposes of exploitation” [1]. There is an estimated 45.8 million women, men, and children around the world that are victims of human trafficking. In the United States alone there are an estimated 58,000 individuals who have been coerced or forced into servitude [2]. Human trafficking remains a critical public health concern that is poorly understood, insufficiently taught [3], and under-researched, especially in the US. These factors may potentially contribute to a lack of understanding and awareness of human trafficking among healthcare professionals. Furthermore, there is a lack of validated screening tools for use in medical settings [4]. It may also explain why highly-skilled and wellintentioned health care providers unknowingly and perhaps sometimes insensitively interact with human trafficking victims [5]. It has been estimated that approximately 88% of human trafficking victims have interacted with a health care professional at some point in their life, although less than 20% of these individuals reported that their health care providers knew of their trafficking status [6]. To address a possible lack of awareness or insensitivity to human trafficking in psychiatry, one of us (JHC) had recently issued a call to action to teach about human trafficking in psychiatric settings [3]. Well-informed providers may find that they are ill-equipped or constrained by their treatment settings to effectively screen for and treat trafficking victims due to the complexity of the biopsychosocial issues with which these victims may present [7]. Educating staff and trainees about human trafficking should increase their vigilance and effectiveness in the identification of human trafficking victims. On our own inpatient unit we have noted a substantial increase in the number of patients that have screened positive for human trafficking given routine screening and improved awareness. A trauma-informed and patient-centered care model allows for a predictably safe, confidential and therapeutic treatment setting on a multidisciplinary unit. We suggest that psychiatric inpatient units can play key role in identifying, treating, and advocating for human trafficking victims due to their multidisciplinary and integrated care approach to addressing patients' biopsychosocial issues. We searched PubMed using the terms “human trafficking” and “inpatient psychiatry” and found no papers that explored the important role
http://dx.doi.org/10.1016/j.genhosppsych.2017.02.006 0163-8343/© 2017 Elsevier Inc. All rights reserved.
that acute psychiatric inpatient units could play in the identification and treatment of human trafficking victims. We then combined the search term “human trafficking” with the following terms in separate searches: cognitive impairment, counseling, chronic mental illness, risk factors, substance use, and vulnerability and found no papers that described human trafficking patients in North American psychiatric settings. There is some evidence from England that victims of human trafficking have a higher likelihood of being admitted to psychiatric inpatient units than non-trafficked patients [8]. This adds to the importance that this topic be addressed clinically, educationally, and empirically. Through our work on an acute psychiatric inpatient unit, we have learned that sex and labor trafficking patients come from extremely diverse backgrounds and can vary greatly in terms of age, gender, race, culture, immigration status, and socioeconomic background [9]. They also vary in the ways in which they have been victimized, and whether being currently or previously trafficked. There are factors that can increase an individual's vulnerability to trafficking. These include youth, a history of childhood abuse, homelessness, belonging to a sexual minority group (i.e. LGBTQ identified), cognitive or physical disability, being a migrant worker, having low socioeconomic status, and being a racial or ethnic minority [7,10]. Psychiatric inpatient units should expect to see these patients being admitted because many of the vulnerabilities that led to victimization are common to patients with major mental disorders. When working with trafficking victims, however, it is important to remember that any individual has the potential to have been a victim of human trafficking [11]. Thus, providers must maintain a constant state of vigilance for the relevant signs and symptoms. Rules of confidentiality can create much needed space between patients and their traffickers which in turn can increase the chances that suspected trafficking victims will be forthcoming and properly identified. There are many factors that may contribute to a lack of recognition of human trafficking victims in treatment settings. Patients are sometimes reluctant or ashamed to talk about personal and often painful past experiences [5]. Past negative experiences with providers [5], cultural mistrust of health care professionals, or fear of law enforcement/ immigration officials may transfer to treatment members and inhibit disclosure from victims [12,13]. Inpatient psychiatric units can provide additional opportunities for treatment team members to develop positive working alliances with suspected trafficking victims facilitating disclosure and the appropriate targeting of interventions and referrals. Inpatient units also provide an opportunity for patients to stabilize and to begin to process their experiences. Another primary reason that trafficked patients may not be identified is that their psychiatric conditions prevent them from accurately reporting their trafficking history and status. Patients may present as acutely psychotic, manic, agitated, or delirious. In an acute or decompensated status, patients may not be as reliable or forthcoming about
42
Editorial
their backgrounds or histories. We suggest, therefore, that providers maintain high vigilance for human trafficking beyond the initial assessment point and rescreen patients when the mental status improves. Additionally, we recognize that many health care providers may be reluctant to ask patients about possible trafficking experiences because of the potentially disturbing information that is disclosed. This discomfort on the part of providers may also contribute to the reluctance of human trafficking victims to identify themselves in health care settings [5,6]. Nevertheless, training health care providers to effectively identify human trafficking victims is both an ethical and moral imperative. Obtaining an accurate accounting of trafficking history can lead to more effective treatment plans, recommendations, and better overall outcomes and can reduce the potential for individuals becoming re-victimized. Psychiatric inpatient units may provide more time to carry out treatment interventions that can lead to a reduction in patients' vulnerability to being trafficked. Human trafficking victims benefit greatly when provided a safe, stable, and predictable environment, particularly because they have often been subjected to violence and are at elevated risk of physical and mental health problems [14,15]. Psychiatric inpatient units are a desirable treatment setting for human trafficking victims because of the relatively slower pace, good patient-to-provider ratio, and multidisciplinary nature of the biopsychosocial interventions. A patient-centered, trauma-informed, and multifaceted approach is essential for managing victims of human trafficking [7]. Thus, unit staff must work collaboratively to minimize victims' exposure to agitated or aggressive patients to decrease the potential that victims are re-traumatized. Providers at different levels of care and stages in training may interact with patients and provide them with safe spaces to talk about and process the details of their trafficking history. An integrated care approach will facilitate consultation with other medical, surgical and gynecological disciplines when indicated, and ensure that human trafficking victims have adequate access to quality healthcare, including substance abuse treatment options. Human trafficking victims may have very limited access to appropriate health care [16] and it is important to rectify any such barriers to treatment. Understanding a patient's trafficking history helps inform treatment and interventions which can help break the cycle of re-victimization. We assume that treatment of underlying psychiatric vulnerabilities can improve patients' mental status, but it can also help patients to make better use of available psychological and social service resources. Social work should be consulted to help patients minimize stressors by providing them access to a wide variety of services and resources. These resources include but are not limited to arranging alternate or transitional housing and connecting victims to vocational rehabilitation agencies, ID programs, food banks, clothing resources, and child/adult protective services. When possible, treatment team members should also try to liaise with local immigration and legal aid agencies to advocate for patients who are undocumented or have legal concerns because of their trafficking history. By its very nature human trafficking is a coercive interaction and victims are forced to do things that are detrimental to their physical and mental well-being. They may have to decide between their own safety and the safety of their loved-ones or have real fears of being deported or incarcerated because of activities that they were involved in during their time of enslavement. Many trafficking victims are forced into illegal activities by their traffickers which may result in criminal charges or outstanding warrants, thereby decreasing their sense of comfort in turning to law enforcement officials for help. With careful consideration of patient and staff safety, and with the understanding that providers can be subpoenaed by the courts, opportunities should also be provided to help trafficking victims make police reports or work with police to bring their traffickers to justice [17]. The psychiatry profession can help bring awareness to this critical public health matter by publishing the work that takes place in various psychiatric settings with human trafficking victims. There is a dearth of research that specifically examines how psychiatric factors can affect
patients' potential for being trafficked, especially here in the United States. Additionally, we should maintain a sense of vigilance and routinely screen (and rescreen) for trafficking victims as their conditions improve. We must work towards validating a human trafficking screen that can be used effectively with patients with psychiatric conditions. We should also keep in mind how different psychiatric conditions can complicate the identification of victims and hinder self-disclosure from patients. We remind readers that human trafficking victims do not fit into any one particular mold, despite much of the medical literature focused primarily on female sex-trafficking victims from low- and middle-income countries [18]. Biopsychosocial interventions implemented on acute psychiatric inpatient units can interrupt the cycle of victimization and re-victimization by addressing patients' multiple vulnerabilities, helping patients to access available resources, and assisting them with outpatient planning after discharge. Inpatient units are therefore an important locus of care for the management of trafficked victims. Mental health providers are uniquely positioned to identify, treat, and advocate on behalf of trafficking victims because of their training in biopsychosocial assessments and interventions. They can also help educate and train other health care providers and support staff to better identify signs and symptoms of human trafficking and to connect trafficking victims with various advocacy organizations and social service agencies in the community. We should do all we can to help victims make prudent decisions to not return to their traffickers and to assist them in beginning a pathway of recovery. Disclosure On behalf of all authors, the corresponding author states that there is no conflict of interest. References [1] United Nations Office on Drugs and Crime. United Nations convention against transnational organized crime and the protocols thereto [Available from: https://www. unodc.org/documents/treaties/UNTOC/Publications/TOC%20Convention/TOCebooke.pdf. Accessed December 19] ; 2016. [2] The Walk Free Foundation Ltd. The global slavery index; 2016 [Available from: https://www.globalslaveryindex.org. Accessed September 26, 2016]. [3] Coverdale J, Beresin EV, Louie AK, Balon R. Human trafficking and psychiatric education: a call to action. Acad Psychiatry 2016;40:119–23. [4] Bespalova N, Morgan J, Coverdale J. A pathway to freedom: an evaluation of screening tools for the identification of trafficking victims. Acad Psychiatry 2016;40:124–8. [5] Baldwin SB, Eisenman DP, Sayles JN, Ryan G, Chuang KS. Identification of human trafficking victims in health care settings. Health Hum Rights 2011;13:e36–49. [6] Lederer LJ, Wetzel CA. The health consequences of sex trafficking and their implications for identifying victims in health care facilities. Ann Health Law 2014;23:61–91. [7] Macias-Konstantopoulos W. Human trafficking; the role of medicine in interrupting the cycle of abuse and violence. Ann Intern Med 2016;165:582–8. [8] Borschmann R, Oram S, Kinner S, Dutta R, Zimmerman C, Howard L. Self-harm among adult victims of human trafficking who accessed secondary mental health services in England. Psychiatr Serv 2016 [Epub ahead of print]. [9] Turner-Moss E, Zimmerman C, Howard LM, Oram S. Labour exploitation and health: a case series of men and women seeking post-trafficking services. J Immigr Minor Health 2014;16:473–80. [10] The Passage. Understanding and responding to modern slavery within the homelessness sector. Report commissioned by the UK Independent Anti-Slavery Commissioner; 2017. [11] Kerr PL. Treating trauma in the context of human trafficking: intersections of psychological, social and cultural factors. In: Ghafoori B, Caspi Y, Smith S, editors. International Perspectives on Traumatic Stress; 2016. p. 199–221. [12] Benkert R, Peters R, Clark R. Effects of perceived racism, cultural mistrust and trust in providers on satisfaction with care. J Natl Med Assoc 2006;98:1532–40. [13] Rhodes S, Mann Li, Simán F, Song E, Alonzo J. The impact of local immigration enforcement policies on the health of immigrant Hispanics/Latinos in the United States. Am J Public Health 2015;105:329–37. [14] Oram S, Abas M, Bick D, et al. Human trafficking and health: a survey of male and female survivors in England. Am J Public Health 2016;106:1073–8. [15] Ottisova L, Hemmings S, Howard LM, Zimmerman C, Oram S. Prevalence and risk of violence and the mental, physical and sexual health problems associated with human trafficking: an updated systematic review. Epidemiol Psychiatr Sci 2016; 12:1–25 [Epub ahead of print]. [16] Zimmerman C, Hossain M, Watts C. Human trafficking and health: a conceptual model to inform policy, intervention and research. Soc Sci Med 2011;73:327–35.
Editorial [17] Gibbons P, Stoklosa H. Identification and treatment of human trafficking victims in the emergency department: a case report. J Emerg Med 2016;50:715–9. [18] Oram S, Stöckl H, Busza J, Howard LM, Zimmerman C. Prevalence and risk of violence and the physical, mental, and sexual health problems associated with human trafficking: systematic review. PLoS Med 2012;9:e1001224.
Phuong T. Nguyen* John H. Coverdale Mollie R. Gordon Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, Houston, TX, United States
43
⁎Corresponding author at: One Baylor Plaza, MS 350, Houston, TX 77030, United States. E-mail address: [email protected] (P.T. Nguyen). 20 February 2017 Available online xxxx