67400 • Addressing Human Trafficking: A Guide for Healthcare Professionals

Table of Contents

67400 • Addressing Human Trafficking: A Guide for Healthcare Professionals

How to Receive Credit

Course Overview

Audience

Accreditations & Approvals

Designations of Credit

Special Approvals

Course Objective

Learning Objectives

Faculty

Faculty Disclosure

Division Planner

Division Planner Disclosure

Director of Development and Academic Affairs

Director Disclosure Statement

About the Sponsor

Disclosure Statement

Implicit Bias in Health Care

1. UNDERSTANDING HUMAN TRAFFICKING

2. RISK FACTORS AND VULNERABLE POPULATIONS

3. HEALTH CONSEQUENCES

DENTAL CONSEQUENCES

SEXUAL/REPRODUCTIVE HEALTH CONSEQUENCES

PSYCHOLOGICAL AND MENTAL HEALTH CONSEQUENCES

4. IDENTIFICATION OF TRAFFICKING VICTIMS

5. TRAUMA-INFORMED ASSESSMENT AND CARE

6. CLINICAL RESPONSE

7. REPORTING REQUIREMENTS

8. RESOURCES FOR VICTIMS

9. CONCLUSION

Works Cited

Evidence-Based Practice Recommendations Citations

67400 • Addressing Human Trafficking: A Guide for Healthcare Professionals

Alice Yick Flanagan, PhD, MSW

www.netce.com

Copyright © 2026 NetCE, All rights reserved.

Human trafficking is a crime and public health issue involving exploitation for labor, services, or commercial sex. Federal law recognizes sex trafficking and forced labor as primary forms of trafficking; force, fraud, or coercion is not required when a minor is involved in a commercial sex act. Health professionals may encounter trafficked persons in emergency departments, clinics, behavioral health settings, dentistry, pharmacy, rehabilitation, pediatrics, women's health, and other care environments, often without direct disclosure.

67400 • Addressing Human Trafficking: A Guide for Healthcare Professionals

Education Category. Ethics - Human Rights

Release Date. 09/01/2026

Expiration Date. 08/31/2029

How to Receive Credit

To complete this course for continuing education credit please go to http://www.netce.com/course/3653 in your browser.

For assistance with receiving continuing education credit, please contact us at help@netce.com.

Course Overview

Human trafficking is a crime and public health issue involving exploitation for labor, services, or commercial sex. Federal law recognizes sex trafficking and forced labor as primary forms of trafficking; force, fraud, or coercion is not required when a minor is involved in a commercial sex act. Health professionals may encounter trafficked persons in emergency departments, clinics, behavioral health settings, dentistry, pharmacy, rehabilitation, pediatrics, women's health, and other care environments, often without direct disclosure.

Audience

This introductory course is designed for all psychologists involved in identifying, intervening in, and preventing cases of human trafficking.

Accreditations & Approvals

Continuing Education (CE) credits for psychologists are provided through the co-sponsorship of the American Psychological Association (APA) Office of Continuing Education in Psychology (CEP). The APA CEP Office maintains responsibility for the content of the programs. NetCE is recognized by the New York State Education Department's State Board for Psychology as an approved provider of continuing education for licensed psychologists #PSY-0240. This course is considered self-study by the New York State Board for Psychology.

Designations of Credit

NetCE designates this continuing education activity for 1 credit(s).

Special Approvals

This course fulfills the Michigan requirement for training in identifying victims of human trafficking.

Course Objective

The purpose of this course is to prepare psychologists to recognize signs, conduct trauma-informed assessment, provide patient-centered support, meet mandatory reporting obligations, and connect patients with national and state-specific resources.

Learning Objectives

Upon completion of this course, you should be able to:

1. Define human trafficking and its various forms.

2. Identify risk factors and populations vulnerable to human trafficking.

3. Outline the potential health consequences of human trafficking.

4. Use trauma-informed assessment and care practices to respond safely in cases of suspected trafficking.

5. Describe reporting and referral resources.

Faculty

Alice Yick Flanagan, PhD, MSW, received her Master’s in Social Work from Columbia University, School of Social Work. She has clinical experience in mental health in correctional settings, psychiatric hospitals, and community health centers. In 1997, she received her PhD from UCLA, School of Public Policy and Social Research. Dr. Yick Flanagan completed a year-long post-doctoral fellowship at Hunter College, School of Social Work in 1999. In that year she taught the course Research Methods and Violence Against Women to Masters degree students, as well as conducting qualitative research studies on death and dying in Chinese American families.

Previously acting as a faculty member at Capella University and Northcentral University, Dr. Yick Flanagan is currently a contributing faculty member at Walden University, School of Social Work, and a dissertation chair at Grand Canyon University, College of Doctoral Studies, working with Industrial Organizational Psychology doctoral students. She also serves as a consultant/subject matter expert for the New York City Board of Education and publishing companies for online curriculum development, developing practice MCAT questions in the area of psychology and sociology. Her research focus is on the area of culture and mental health in ethnic minority communities.

Faculty Disclosure

Contributing faculty, Alice Yick Flanagan, PhD, MSW, has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.

Division Planner

Margaret Donohue, PhD

Division Planner Disclosure

The division planner has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.

Director of Development and Academic Affairs

Sarah Campbell

Director Disclosure Statement

The Director of Development and Academic Affairs has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.

About the Sponsor

The purpose of NetCE is to provide challenging curricula to assist healthcare professionals to raise their levels of expertise while fulfilling their continuing education requirements, thereby improving the quality of healthcare.

Our contributing faculty members have taken care to ensure that the information and recommendations are accurate and compatible with the standards generally accepted at the time of publication. The publisher disclaims any liability, loss or damage incurred as a consequence, directly or indirectly, of the use and application of any of the contents. Participants are cautioned about the potential risk of using limited knowledge when integrating new techniques into practice.

Disclosure Statement

It is the policy of NetCE not to accept commercial support. Furthermore, commercial interests are prohibited from distributing or providing access to this activity to learners.

Implicit Bias in Health Care

The role of implicit biases on healthcare outcomes has become a concern, as there is some evidence that implicit biases contribute to health disparities, professionals' attitudes toward and interactions with patients, quality of care, diagnoses, and treatment decisions. This may produce differences in help-seeking, diagnoses, and ultimately treatments and interventions. Implicit biases may also unwittingly produce professional behaviors, attitudes, and interactions that reduce patients' trust and comfort with their provider, leading to earlier termination of visits and/or reduced adherence and follow-up. Disadvantaged groups are marginalized in the healthcare system and vulnerable on multiple levels; health professionals' implicit biases can further exacerbate these existing disadvantages.

Interventions or strategies designed to reduce implicit bias may be categorized as change-based or control-based. Change-based interventions focus on reducing or changing cognitive associations underlying implicit biases. These interventions might include challenging stereotypes. Conversely, control-based interventions involve reducing the effects of the implicit bias on the individual's behaviors. These strategies include increasing awareness of biased thoughts and responses. The two types of interventions are not mutually exclusive and may be used synergistically.

1. UNDERSTANDING HUMAN TRAFFICKING

The United Nations defines human trafficking as [1]:

The recruitment, transportation, transfer, harbouring or receipt of persons, by means of 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, or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation. Exploitation shall include, at a minimum, the exploitation or the prostitution or other forms of sexual exploitation, forced labour or services, slavery or practices similar to slavery, servitude, or the removal of organs.

In essence, this definition involves three elements: force, coercion, and fraud [2]. The United Nations Office on Drugs and Crime divides the definition of human trafficking into three sections: the act, means, and purpose [3]. The act, or what is done, generally refers to activities such as recruitment, transportation, transfer, harboring, or receipt of persons. The means of trafficking consists of threats or use of force, coercion, abduction, fraud, deception, abuse of power or vulnerability, or giving payments or benefits to a person in control of the victim. Finally, these acts are carried out for the purpose of exploitation, which includes prostitution, sexual exploitation, forced labor, slavery or forced servitude, and the removal of organs [3].

The TVPA defines human trafficking to include both sex trafficking and labor trafficking [4]:

Sex trafficking is the recruitment, harboring, transportation, provision, obtaining, patronizing, or soliciting of a person for the purposes of a commercial sex act, in which the commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such an act has not attained 18 years of age. Labor trafficking is the recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, through the use of force, fraud, or coercion for the purposes of subjection to involuntary servitude, peonage, debt bondage, or slavery. A victim need not be physically transported from one location to another for the crime to fall within this definition.

In many cases, women and children are considered the typical victims of human trafficking. Hart posits that women are more vulnerable to trafficking due to the lack of social safety nets in many developing countries [5]. Coupled with women's subordinate social status in many cultures, this leads to the "feminization of poverty." Although the social conditions may make women and children more vulnerable to human trafficking, the reality is that men are also victims of human trafficking.

Evidence Based Practice Recommendation

According to the World Health Organization, a minimum condition for healthcare providers to ask women about violence is that it is safe to do so (i.e., the perpetrator is not present); they must be trained on the correct way to ask and on how to respond to women who disclose violence.

https://apps.who.int/iris/bitstream/handle/10665/85240/9789241548595_eng.pdf

Last Accessed: August 17, 2026

Level of Evidence: Expert Opinion/Consensus Statement

Overall, the definition of human trafficking is ambiguous because of the many intersections with other issues (e.g., sexual abuse, domestic violence, forced marriage, forced labor) [6]. It occurs both domestically and internationally but is primarily a hidden problem. This makes research efforts, the prosecution of perpetrators, and policy and community efforts to protect victims even more challenging [6]. It is vital to remember that trafficking, as defined by U.S. law, does not require crossing international or even state borders. The transport of victims from one locale to another is not a necessary component of determining whether human trafficking has occurred.

When evaluating a possible case of human trafficking, the clinical question is not "Can the patient prove trafficking?" but "Are there safety, coercion, injury, or control indicators that warrant private assessment, support, and referral?" [7].

2. RISK FACTORS AND VULNERABLE POPULATIONS

Trafficking risk is shaped by vulnerability, unmet needs, isolation, coercion, and power imbalance rather than by a single demographic trait. Factors that can increase vulnerability include homelessness or housing instability, runaway status, child welfare or juvenile justice involvement, prior abuse, family violence, poverty, unstable immigration status, limited English proficiency, disability, social isolation, substance use, and disconnection from stable support networks. Members of stigmatized groups, including LGBTQ+ youth and people with disabilities, may experience elevated vulnerability because discrimination, family rejection, barriers to services, and economic insecurity can be exploited by traffickers; the risk is produced by social conditions, not by identity itself [7,8].

Labor trafficking vulnerabilities often involve recruitment for promised work that becomes unsafe, underpaid, unpaid, debt-controlled, or impossible to leave. Examples include agriculture, restaurants, domestic work, hospitality, factories, health/beauty services, construction, traveling sales, caregiving, and other service industries. Traffickers may exploit debt, immigration fears, threats to family, confiscated identification, dependency, substance use, or lack of transportation and documentation [7,9].

3. HEALTH CONSEQUENCES

In studies of trafficked persons, headaches, fatigue, dizziness, back pain, pelvic pain, stomach pain, sexually transmitted infections (STIs), unwanted pregnancies, and gynecologic infections were common, generally the result of continual physical, psychological, and sexual abuse [10] [11]. Victims of labor trafficking also experience health issues related to the type of work, workplace conditions, malnutrition, and violence [12]. It is important to remember that some of these somatic complaints, such as headaches, fatigue, and gastrointestinal problems, may be underlying symptoms of anxiety, depression, and stress [11]. Some cultural groups might not use the terms "depression," "sad," or "anxious," but may use metaphors and somatic symptoms to describe their pain, all of which are embedded within cultural ideologies. The most common culture-based idioms of distress are somatic symptoms. Some groups tend not to psychologize emotional problems; instead, they experience psychological conflicts as bodily sensations (e.g., headaches, bodily aches, gastrointestinal problems, and dizziness).

Among child victims of human trafficking, healthy growth and development are especially problematic. Malnourishment and poor hygiene often lead to delayed bone growth, poorly formed teeth, and early dental caries [14]. The intense nature of child labor also has severe negative physical and health consequences.

DENTAL CONSEQUENCES

Victims may present with dental trauma and loss of teeth from violent acts. Injuries to the face and mouth area are common in abuse cases, and the potential for tooth involvement is high. Other dental problems arise as well, including infectious complications due to HIV, and even oral cancers or gingival disease due to substance use or poor access to dental care [15].

SEXUAL/REPRODUCTIVE HEALTH CONSEQUENCES

In the context of forced sex work among trafficked victims, safeguards against infection (e.g., regular condom use), early diagnosis, and adequate antimicrobial treatment are inconsistently employed or absent entirely [13]. Consequently, in addition to unwanted pregnancy, the risk for pelvic inflammatory disease and subsequent infertility is relatively high. Moreover, the relationship between forced sex work and HIV infection is stronger when sexual violence is involved. Women who are forced into sex work are 11 times more likely to become HIV-infected than women who engage in consensual sex work [16]. Sexual violence may increase the transmission risk as a result of open abrasions and injuries to the vagina. Furthermore, sexual violence can negatively impact self-esteem, which could then deter victims from advocating more strongly for condom use [16].

PSYCHOLOGICAL AND MENTAL HEALTH CONSEQUENCES

Victims of trafficking experience a host of psychological, mental health, and emotional distress. Depression, suicidal ideation, substance use, and anxiety are typically cited mental health problems [10]. Post-traumatic stress disorder (PTSD) is also common given the trauma many victims experience, including physical and/or sexual violence and abuse; victims forced into sex work experience continual, daily sexual assault [17].

There is also some evidence that trafficked victims may experience complex PTSD, a type of PTSD that involves an acute change of the victims' sense of self, their relationship with others, and their relationship with God or a higher being [19]. These persons direct anger inwardly (toward themselves) as well as toward their perpetrators, which results in a loss of faith in themselves and the world [18,19,20]. Perhaps due to self-directed anger and shame, some will engage in risky sexual behaviors, self-harm, and substance abuse. Some victims also have difficulty managing and expressing how they are feeling, while others experience dissociation [18].

Substance abuse is also common among victims. In interviews, trafficked women discussed how traffickers forced them to use substances like drugs and/or alcohol so they could work longer hours, take on more clients, and/or perform sexual acts that they could not normally perform [13]. Other victims used substances as a means to cope with their situations.

Children forced into labor experience grueling hours and are frequently beaten by their captors. Underage victims of domestic sex trafficking fluctuate through a range of emotions, including despair, shame, guilt, hopelessness, anxiety, and fear [21]. Depending upon the level of trauma, some engage in self-destructive behaviors like self-mutilation or suicide attempts. For some, their ambivalence toward the perpetrators may be confusing. On the one hand, they want to escape the abuse, yet simultaneously, they may have a sort of traumatic bond with the perpetrators [21].

4. IDENTIFICATION OF TRAFFICKING VICTIMS

Healthcare providers are often the most likely to encounter a victim of human trafficking under circumstances that provide an opportunity to intervene, and victims may be encountered in most mental health and healthcare venues. One study estimated that 30% to 87.8% of victims accessed medical services at some point during their trafficking [22].

Because human trafficking and exploitation are, by nature, covert processes, the identification and rescue of the victim can be difficult. Identification relies on patterns rather than a single sign. General indicators include scripted or inconsistent histories, inability or hesitation to answer questions, an accompanying person who controls communication or refuses privacy, fearfulness, avoidance of eye contact, lack of control over identification or money, inability to provide an address, not knowing location/date/time, wages withheld, or not being allowed breaks, food, water, or protective equipment. Sex trafficking indicators include a minor involved in commercial sex, branding tattoos, unusually high numbers of sexual partners, venue-inappropriate clothing, or language associated with commercial sexual exploitation. Labor trafficking indicators include threats or abuse by an employer, debt to an employer or recruiter, required employer-provided housing, different work than promised, unsafe work, and inadequate protective equipment [7].

Across settings, red flags differ. Emergency clinicians may see assault injuries, strangulation concerns, overdose, suicidal ideation, or recurrent visits. Primary care may identify chronic pain, inconsistent history, untreated illness, or someone speaking for the patient. Women's health and pediatrics may detect pregnancy concerns, sexually transmitted infections, runaway history, or controlling adults. Behavioral health professionals may identify trauma bonding, dissociation, substance use, or coercive relationship dynamics. Dentists may observe oral trauma, dental neglect, or fear of speaking privately. Pharmacists may note controlled access to medications or a third party answering for the patient. Physical and occupational therapists may see injuries inconsistent with function, workplace hazards, restricted mobility, or employer control of appointments [7,9]. It is important that the entire clinical picture is considered.

5. TRAUMA-INFORMED ASSESSMENT AND CARE

All interactions with patients, regardless of whether or not they are potential victims of trafficking, should be centered on the patient's experiences, needs, and preferences. Providing patient-centered care means that care will be respectful of and responsive to individual patient preferences, needs, and values and will reflect the patient's values. This should be considered at all stages of assessment, intervention, and continued care/follow-up.

It is important to use a trauma-informed approach when assessing and caring for potential victims, which requires that practitioners understand the impact of trauma on all areas of an individual's life [23]. Physical, emotional, and psychological safety is at the heart of trauma-informed care. This approach allows for trust-building and continued communication, two factors that are vital to ensuring that patients receive the care and support they require.

Trauma-informed assessment emphasizes privacy, choice, transparency, and safety. Before sensitive questions, the clinician should assess whether questioning could increase danger, seek a private setting, use a professional interpreter unrelated to the patient or companion, explain confidentiality and mandatory-reporting limits, and avoid making disclosure the goal of the encounter. HEAL Trafficking's PEARR framework describes a patient-centered conversation guide, not a rigid screening checklist, and emphasizes survivor agency and autonomy [7,24]:

- Provide privacy

- Educate

- Ask

- Respect

- Respond

Suggested, nonjudgmental prompts include: "Is anyone preventing access to food, rest, money, documents, or medical care?" "Does anyone threaten harm if work or services stop?" "Is there a safe way to contact the patient after this visit?" "Would the patient like help connecting with a confidential advocate?" Documentation should be objective: injuries, patient statements in quotation marks when clinically necessary, behavior observed, safety concerns, referrals offered, reporting rationale, and patient preferences. Documentation may later help, but unnecessary details can also create safety and legal risks; therefore, charting should be accurate, clinically relevant, and consistent with facility policy [7].

6. CLINICAL RESPONSE

The immediate clinical priorities are medical stabilization, safety assessment, behavioral health support, and connection to options. A victim-centered response recognizes that not all patients will disclose, accept services, contact law enforcement, or leave the situation during the encounter. Clinicians should avoid coercive "rescue" attempts, avoid confronting a suspected trafficker, and avoid making promises that cannot be kept; instead, the team should create privacy, explain choices, offer resources, and coordinate with trained social work, advocacy, child protection, adult protection, forensic nursing, behavioral health, security, and legal/risk teams, as indicated [7,24].

If the patient is in immediate danger, follow emergency and institutional protocols. Safety planning should be based on the unique needs and circumstances of the individual. One should also take steps to ensure that one's own safety is also protected.

If the patient is an adult with capacity and no mandatory-reporting trigger applies, obtain consent before disclosing identifiable information externally, unless HIPAA and state law permit disclosure because the report is required by law, the patient agrees, disclosure is authorized for abuse/neglect/domestic violence reporting, or disclosure is necessary to prevent or lessen a serious and imminent threat. Warm handoffs are preferable to "cold" referral lists: whenever safe, connect the patient directly with a hotline advocate, victim services provider, social worker, or community agency before discharge [7,25].

7. REPORTING REQUIREMENTS

Reporting depends on age, capacity, setting, injury type, state law, and whether the patient is a child or vulnerable adult (Table 1). If screening indicate that an individual may be a victim of human trafficking, one should contact the National Human Trafficking Hotline at 1-888-373-7888; hotline staff may report situations involving a harmed person 17 years of age or younger or anyone in immediate danger when identifying information is shared. HIPAA permits disclosure without authorization when required by law and permits certain disclosures for public health, child abuse/neglect, abuse/neglect/domestic violence, law enforcement, and serious threats, subject to regulatory conditions [25].

Table 1: REPORTING REQUIREMENTS FOR HUMAN TRAFFICKING VICTIMS IN SELECT STATESa

State

Action Required

Primary Reporting Agency

Contact Information

Children (Younger than 18 Years of Age)

California

Mandatoryfor mandated reporters when there is reasonable suspicion of child abuse or neglect, including commercial sexual exploitation/human trafficking.

Child Protective Services (county level) or local law enforcement

https://www.cdss.ca.gov/reporting/report-abuse/child-protective-services/report-child-abuse

New York

Mandatoryfor mandated reporters when there is reasonable cause to suspect child abuse or maltreatment by a parent or person legally responsible. Commercial sexual exploitation may trigger reporting depending on the circumstances.

Statewide Central Register of Child Abuse and Maltreatment (SCR)

Public: 800-342-3720

Mandated Reporters: 800-635-1522

https://ocfs.ny.gov/programs/cps/

Michigan

Mandatoryfor physicians, nurses, and other mandated reporters who have reasonable cause to suspect child abuse or neglect, including trafficking or commercial sexual exploitation.

Michigan Department of Health and Human Services, Children's Protective Services

Abuse and Neglect Hotline: 855-444-3911

Texas

According to Texas Family Code 261.101, any person having cause to believe that a child's physical or mental health or welfare has been adversely affected by abuse or neglect (including human trafficking victimization) by any person is required to immediately make a report to law enforcement or DFPS.

Department of Family and Protective Services (DFPS), or law enforcement, as appropriate

800-252-5400

https://www.txabusehotline.org

Florida

Mandatory for every person. Any person who knows or has reasonable cause to suspect child abuse, abandonment, neglect, or commercial sexual exploitation must report immediately.

Florida Department of Children and Families Abuse Hotline

800-962-2873

https://reportabuse.myflfamilies.com

Connecticut

Mandatory for designated mandated reporters who suspect child abuse or neglect, including trafficking-related abuse.

Department of Children and Families (DCF) Child Abuse and Neglect Careline

800-842-2288

https://portal.dcf.ct.gov/Portal/CPSOR

Ohio

Mandatory for healthcare professionals and other mandated reporters who know or reasonably suspect child abuse or neglect, including trafficking-related abuse.

Public Children Services Agency (PCSA) and/or law enforcement

855-O-H-CHILD (855-642-4453)

(This number connects to county agency or law enforcement.)

South Carolina

Mandatory for physicians, nurses, and other mandated reporters who receive information giving them reason to believe a child's physical or mental health or welfare has been or may be adversely affected by abuse or neglect, including sexual exploitation or trafficking.

Department of Social Services, Child Protective Services; law enforcement when appropriate

888-227-3487

https://benefitsportal.dss.sc.gov

Vulnerable Adults/Elders

California

Mandatory for abuse, neglect, abandonment, isolation, financial abuse, or exploitation of elders (≥65) and dependent adults.

Adult Protective Services (APS) or local law enforcement

833-401-0832

(This number connects to the county agency.)

New York

Mandatory only for vulnerable persons receiving services in facilities covered by the Justice Center Act; otherwise, no general APS reporting mandate for community-dwelling competent adults.

Justice Center Vulnerable Persons Central Register and/or county Adult Protective Services office

844-697-3505

https://ocfs.ny.gov/programs/adult-svcs/contact.php#local-aps

Michigan

Mandatory reporting of suspected abuse, neglect, or exploitation of vulnerable adults.

Michigan Department of Health and Human Services, Adult Protective Services

Abuse and Neglect Hotline: 855-444-3911

Texas

State law requires that any person who suspects such mistreatment must report it immediately to the DFPS.

Department of Family and Protective Services (DFPS); Adult Protective Services; law enforcement as appropriate.

800-252-5400

https://www.txabusehotline.org

Florida

Mandatory reporting of abuse, neglect, or exploitation of vulnerable adults.

Florida Department of Children and Families Abuse Hotline

800-962-2873

https://reportabuse.myflfamilies.com

Connecticut

No universal mandatory reporting of abuse involving community-dwelling competent adults; reporting requirements exist for certain licensed facilities and specific populations.

Protective Services for the Elderly; applicable protective agency, depending on setting

888-385-4225

After hours: 211

Ohio

Mandatory reporting of suspected abuse, neglect, or exploitation of adults under protective services statutes when applicable.

Ohio Department of Job and Family Services

855-OHIO-APS (855-644-6277)

https://aps.jfs.ohio.gov

South Carolina

Mandatory reporting of abuse, neglect, or exploitation of vulnerable adults as defined by state law.

Department of Social Services (Adult Protective Services); law enforcement when appropriate

888-CARE4US (888-227-3487)

https://benefitsportal.dss.sc.gov

aClinicians should review the laws of the state in which they practice. Competent adults with decision-making capacity generally retain the right to decline law enforcement involvement or other assistance. However, reporting may be required if certain conditions or injuries are present.

Source: [26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41]

For adults with capacity, the safest default is to explain options and obtain consent before sharing identifiable information unless a mandatory-reporting law or serious-threat exception applies. For minors and vulnerable adults, mandated reporters must follow state-specific child protective services and adult protective services laws. Reports should be factual and limited to required information, and the patient should be told what must be reported unless doing so would increase serious harm [7].

Under the child abuse laws, practitioners who are mandated reporters and who are suspicious that a minor is being abused should immediately report the abuse. For more information regarding specific states' reporting requirements, please visit https://www.littleleague.org/player-safety/child-protection-program/state-specific-information-child-abuse.

In addition, older and dependent adults may be victims of abuse, exploitation, or trafficking. Because these individuals may be especially vulnerable due to reliance on others for care and support, state law may require that any person who suspects such mistreatment must report it immediately. Recognizing and reporting suspected abuse is essential to protecting the safety and dignity of older and dependent adults.

8. RESOURCES FOR VICTIMS

National resources include the National Human Trafficking Hotline at 1-888-373-7888, text 233733, online chat, and the searchable National Human Trafficking Referral Directory for emergency, transitional, and long-term services. State agencies should be consulted, as appropriate. Resource planning should include immediate safety, shelter, food, clothing, medical care, mental health care, substance use care, legal aid, immigration assistance, victim advocacy, transportation, dental care, occupational support, and follow-up. The team should avoid giving printed material if it creates danger; alternatives include helping the patient memorize the hotline number, saving a neutral contact, or arranging a safe callback plan [7,9,25].

9. CONCLUSION

Healthcare professionals are not expected to investigate trafficking; they are expected to recognize indicators, protect privacy and safety, treat health needs, document accurately, comply with reporting laws, and connect patients with survivor-centered resources. Effective response prioritizes autonomy, confidentiality, stabilization, and warm handoffs while recognizing that disclosure may not occur during a single encounter [7,24].

Works Cited

1. United Nations. Protocol To Prevent, Suppress and Punish Trafficking In Persons, Especially Women and Children, Supplementing the United Nations Convention Against Transnational Organized Crime. Available at https://www.ohchr.org/en/instruments-mechanisms/instruments/protocol-prevent-suppress-and-punish-trafficking-persons. Last accessed August 6, 2026.

2. Parreñas RS, Hwang MC, Lee HR. What is human trafficking? A review essay. Signs: J Women Cult Soc. 2012;37(4):1015-1029.

3. United Nations Office on Drugs and Crime. The Crime. Available at https://www.unodc.org/unodc/en/human-trafficking/crime.html. Last accessed August 6, 2026.

4. U.S. Congress. Victims of Trafficking and Violence Protection Act of 2000. Public Law 106-386. Available at https://www.govinfo.gov/content/pkg/PLAW-106publ386/pdf/PLAW-106publ386.pdf. Last accessed August 6, 2026.

5. Hart A. Power, Gender and Human Trafficking. Paper presented at the Annual Meeting of the American Sociological Association; New York, NY; August 11, 2007.

6. Hume DL, Sidun NM. Human trafficking of women and girls: characteristics, commonalities, and complexities. Women Ther. 2017;40(1-2):7-11.

7. Administration for Children and Families/Office on Trafficking in Persons. Identifying Victims of Human Trafficking: What to Look for in Health Care Settings. Available at https://humantraffickinghotline.org/sites/default/files/What%20to%20Look%20for%20during%20a%20Medical%20Exam%20-%20FINAL%20-%202-16-16.docx.pdf. Last accessed August 6, 2026.

8. State of Michigan. Human Trafficking Red Flags for Healthcare Professionals. Available at https://www.michigan.gov/ag/-/media/Project/Websites/AG/human-trafficking/Updated-Red-Flags-for-Responders/Red-Flags-Healthcare-Professionals-2025.pdf?rev=01de215aa09a432fad5a9e5fd769138d. Last accessed August 6, 2026.

9. Texas Health and Human Services. Texas Human Trafficking Resource Center. Available at https://www.hhs.texas.gov/services/family-safety-resources/texas-human-trafficking-resource-center. Last accessed August 6, 2026.

10. Greenbaum J. Child sex trafficking and commercial sexual exploitation. Adv Pediatr. 2018;65(1):55-70.

11. Zimmerman C, Hossain M, Yun K, et al. The health of trafficked women: a survey of women entering posttrafficking services in Europe. Am J Public Health. 2008;98(1):55-59.

12. Pocock NS, Tadee R, Tharawan K, et al. "Because if we talk about health issues first, it is easier to talk about human trafficking:" findings from a mixed methods study on health needs and service provision among migrant and trafficked fishermen in the Mekong. Global Health. 2018;14(1):45.

13. Zimmerman C, Yun K, Shvab I, et al. The Health Risks and Consequences of Trafficking in Women and Adolescents: Findings from a European Study. London: London School of Hygiene and Tropical Medicine; 2003.

14. U.S. Administration for Children and Families. Look Beneath the Surface. Available at https://www.acf.hhs.gov/otip/partnerships/look-beneath-the-surface. Last accessed January 2, 2024.

15. U.S. Department of Health and Human Services. Human Trafficking and Health Professionals: Questions and Answers. Available at https://aspr.hhs.gov/at-risk/Pages/human_trafficking_faqs.aspx. Last accessed January 2, 2024.

16. Wirth KE, Tchetgen EJ, Silverman JG, Murray MB. How does sex trafficking increase the risk of HIV infection? An observational study from Southern India. Am J Epidemiol. 2013;177(3):232-241.

17. Sigmon JN. Combatting modern-day slavery: issues in identifying and assisting victims of human trafficking worldwide. Vict Offender. 2008;3(2/3):245-257.

18. Oram S, Domoney J. Responding to the mental health needs of trafficked women. Healthcare Counselling Psychother J. 2018;18(2):10-15.

19. Blumhofer R, Shah N, Grodin M, Crosby S. Clinical issues in caring for former chattel slaves. J Immigr Minor Health. 2011;13(2):323-332.

20. Pascual-Leone A, Kim J, Morrison O-P. Working with victims of human trafficking. J Contemp Psychother. 2017;47(1):51-59.

21. Clawson HJ, Goldblatt GL. Finding a Path to Recovery: Residential Facilities for Minor Victims of Domestic Sex Trafficking. Available at https://aspe.hhs.gov/reports/finding-path-recovery-residential-facilities-minor-victims-domestic-sex-trafficking-0. Last accessed January 2, 2024.

22. Schwarz C, Unruh E, Cronin K, Evans-Simpson S, Britton H, Ramaswamy M. Human Trafficking Identification and Service Provision in the Medical and Social Service Sectors. Health Hum Rights. 2016;18(1):181-192.

23. Greenbaum VJ. Child sex trafficking in the United States: challenges for the healthcare provider. Plos Med. 2017;14(11):e1002439.

24. HEAL Trafficking. PEARR Tool: Trauma-Informed Approach to Victim Assistance in Healthcare Settings. Available at https://www.healtrafficking.org/resources/pearr-tool. Last accessed August 6, 2026.

25. National Human Trafficking Hotline. Report Trafficking. Available at https://humantraffickinghotline.org/en/report-trafficking. Last accessed August 6, 2026.

26. California Penal Code §§11165.1–11174.3 Child Abuse and Neglect Reporting Act.

27. California Welfare and Institutions Code §§15630–15632 Elder and Dependent Adult Civil Protection Act.

28. New York Social Services Law §§413–420 Child Abuse Reporting.

29. New York Social Services Law §§488–493 Justice Center Act.

30. Michigan Child Protection Law MCL 722.621–722.638.

31. Michigan Adult Protective Services Act MCL 400.11 et seq.

32. Texas Family Code §§261.101–261.109.

33. Texas Human Resources Code Chapter 48.

34. Florida Statute §§39.201–39.206.

35. Florida Statute §§415.102, §§415.1034.

36. Connecticut General Statutes §17a-101 et seq.

37. Connecticut General Statutes §§17b-450 et seq.

38. Ohio Revised Code §2151.421.

39. Ohio Revised Code §§5101.60–5101.71.

40. South Carolina Code of Laws. §§63-7-310 et seq.

41. South Carolina Code of Laws. §§43-35-25 and 43-35-35 Omnibus Adult Protection Act.

Evidence-Based Practice Recommendations Citations

1. World Health Organization. Responding to Intimate Partner Violence and Sexual Violence against Women: WHO Clinical and Policy Guidelines. Geneva: World Health Organization; 2013. Available at https://apps.who.int/iris/bitstream/handle/10665/85240/9789241548595_eng.pdf. Last accessed August 17, 2026.