The Trafficking Victims Protection Act
(TVPA) was enacted in 2000 as one of the most significant federal laws in the 21st century. This law defined and criminalized human trafficking (HT) with the goal of eradicating the crime and protecting its victims [1
]. In the last two decades, society at-large has become increasingly aware of this crime and the atrocities victims suffer under the oppression of their traffickers and the ramifications it has on their health outcomes [2
]. Civil society, as well as governmental and nongovernmental agencies, have fought against this crime by updating the initial law and creating subsequent laws at the state level [7
]. These efforts have also included educating the public and creating protocols to identify victims in a diversity of sectors, as well as evaluation of anti-trafficking efforts nationally and internationally [6
]. However, there continues to be gaps in the efforts of prevention, intervention, and legislation at multiple levels within the US and abroad; especially among adult victims [7
]. This research focuses on sex trafficking (ST) survivors’ recommendations to healthcare providers regarding best practices based on their experiences and interactions with a range of diverse healthcare settings and providers. Given the complexities in the victimization and identification of ST-patients; the framework of care here presented—Compassionate Care
—could potentially assist healthcare providers to identify, support and assist ST-patients. Although ST-patients may overlap with other vulnerable populations in the healthcare setting, it is imperative to understand that ST-patients require specific assessment and treatment in order to meet their medical and other needs. Failing to recognize their victimization leads to inadequately providing them with the right resources to support their transition to survivorship [4
]. What is worse, if the healthcare setting is not equipped to support such a population after identification, this could place the ST-patient in a greater danger.
HT continues to be an egregious crime committed against the most vulnerable of victims, particularly women and children [13
]. Within HT there are different types of exploitation. TVPA defines ST when there is “recruitment, harboring, transportation, provision, or obtaining of a person for the purpose of a commercial sex act” [1
]. When this type of crime is committed against a minor, the absence of force, fraud or coercion does not disregard trafficking as a crime, and it is considered a severe form of trafficking [1
]. Other severe
forms of trafficking occur when a person is entrapped into “involuntary servitude, peonage, debt bondage, or slavery” [1
]. In practices, victims of ST are subject to strategic deception, confinement, reidentification, and exposure to violence, danger, and drugs. These strategies are used by traffickers in order to manipulate and control their victims. Therefore, trafficked victims, whether in the US or abroad, do not have the freedom to simply leave their perpetrators [1
1.1. Marginalized Groups with Higher Risks for Sex Trafficking
In society, there are several marginalized groups who are at a higher risk of becoming trafficked. Their vulnerabilities originate from a diversity of needs—physical, emotional, social, and financial among others. Additionally, experiences of past trauma and abuse also contribute to becoming a trafficked victim. The literature has identified several characteristics among survivors that speak to the susceptibilities of becoming an easier target for sex traffickers. These characteristics include the following: (a) homelessness or runaway; (b) experiences of abuse or trauma—physical, emotional, or sexual; (c) being part of juvenile correction or child welfare systems; (d) between the ages of 12 and 14; and (e) member of a non-conformant gender group—LGTBQ; or see References [3
]. In all, addressing the wide range of risk factors could lead to also reducing the number of victims of HT.
1.2. Prevalence and Its Challenges
Under TVPA (2000), HT crimes are classified as the fraudulent act of perpetrators exploiting victims into labor or ST or a combination of both [21
]. The violence inflicted on the victims of these industries is grave [18
]. Victims rescued and restored into survivorship have been diagnosed with acute physical and sexual trauma and adverse health effects including mental illness, substance abuse, sexually transmitted diseases, HIV infection, pregnancy, and abortion-related complications [3
]. The estimates of victims of HT are far from reliable due to inconsistencies in the national systematic approach to estimate this criminal activity [11
]. However, some international efforts have led to some estimates that may begin to paint a picture of how many victims exist across the globe. The Global Slavery Index estimates that there are around 403,000 children, women, and men in the US who are forced into an environment of violence and exploitation [23
]. The Polaris-operated US National Trafficking Hotline has intervened in HT incidents involving 23,078 individual survivors: nearly 5859 potential traffickers, and 1905 trafficking businesses. Even though copious literature has quantified data regarding the severe magnitude of this global phenomenon of bondage, there is still a considerable number of cases that have gone unnoticed [23
]. The true extent of its scope and magnitude are unknown.
1.3. Points of Entry—Opportunities for Intervention
To appropriately address HT—both sex and labor, it is vital that medical providers, social services professionals, and trained law enforcement agents, follow effective frameworks and safe protocols to perform appropriate measures in order to assist in the transition from victimization to survivorship when the opportunity arrives [14
]. The literature speaks of collaborative models that work best in addressing ST-patients in the context of healthcare settings. Both coordination of services and needed resources to move beyond victimization are essential [6
]. In the context of healthcare settings, frontline staff, clinicians, and social workers can take first steps to achieve the following: (a) identify HT victims and perpetrators; (b) stabilize and control the HT situation; (c) prepare victims and pass information on to trained investigators; and (d) refer victims to specialized service providers [26
]. Therefore, multidisciplinary teams can provide more efficacious outcomes from victimization, survivorship to restoration [14
Although the estimates of HT may not be completely known, studies have documented that victims of both sex and labor trafficking interact with healthcare providers [7
]. Literature suggests that victims seek and receive medical care at some point of their traumatic experience in bondage due to the constant abuse they experience [26
]. Studies have shown that anywhere between 28–88% of HT victims come into contact with a healthcare provider at some point during their period of victimization [29
]. Thus, these patient–provider interactions create a vital opportunity for intervention. These interactions can potentially facilitate trafficked patients a possible way out from their victimization and oppression. Nonetheless, the nature of victimization resulting from their trafficking creates stereotypes, stigma, and shame. Thus, these psychological processes frequently inhibit their victimization disclosure to healthcare providers [26
]. Research-based training and better systems for their identification could provide a platform for supporting such vulnerable populations [28
]. The intersection of healthcare with trafficked victims is a significant opportunity for identification and support. If clinicians, frontline responders, law enforcement agents and other needed professionals such as public health practitioners seek to adequately assist HT-patients in transitioning from victimization to survivorship, and reintegration to society, strategic approaches must be in place [7
]. This is not to say that these processes are simple. These processes of patient–provider require trust, genuine care, victim-centered, and trauma-informed practices, as well as operating in a supportive institutional environment that has the resources to actually identify, assist, and support trafficked patients [6
It is important to note that through these processes of identifying and assisting such patients, the goal is not to rescue
them. On the opposite, the framework of assisting such population is to provide an integrative
care that provides patients the time and support needed to move beyond victimization (see Discussion Section—Compassionate Care
]. Therefore, here lies the importance of abovementioned qualities of care, as well as best identification protocol practices. Such practices together will assist patients who are trafficked to begin seeing their value and realizing that their healthcare providers could provide the needed support for escaping their entrapment. Thus, healthcare, and social service providers must collaborate as a team to optimize care of the identified ST-patient by ensuring access to suitable resources needed for these transitions [6
1.4. Gaps in the Literature
Despite the US being at the frontline in the anti-trafficking movement, integration of established instruments within community-based healthcare practice is slow-moving [24
]. Regardless of training and curriculum development, there continues to be a gap regarding the efficacy of frontline personnel in identifying, assisting, and supporting a potential transition from victimization to survivorship [7
]. Although an increased awareness about HT has taken place in the US, professionals that could assist victims continue to work in settings with limited use of protocols or vital community resources to increase capacity and efficacy to assist such patients [9
]. To appropriately address the complexity of victimization of trafficked persons, to help victims exit from this coercion into survivorship, a comprehensive and multi-systemic approach are essential in response to their immediate and long-term needs [14
1.5. Significance of this Research
Curriculum development, cross-training and multidisciplinary collaborative models linking disciplines including social work, the law, medicine, public health, and other service-oriented professions trained to support victims and survivors of HT is a high priority for best practices to emerge and assist this vulnerable population [7
]. To create effective training, the voices of survivors of HT are essential to this process. Without incorporating their recommendations in the design, testing, implementation, and evaluation of identification protocols and best collaborative practices, the US will continue to witness inconsistencies in supporting HT-patients across multiple levels [7
]. Therefore, building a robust literature founded on research focused on the recommendations of survivors that derive from their lived experiences when interacting with healthcare providers, is essential. Therefore, this study is one of a handful of research studies that sought to capture the recommendations articulated by a sample of survivors of ST whose insights resulted from their prior interactions with frontline healthcare providers. Consequently, these study participants’ voices provide key insights to create greater ST-patient-centered models of care and identification protocols to support their exiting into survivorship and restoration. Thus, the aim of this study was to systematically gather their recommendations with the goal of informing the future design, implementation, and evaluation of evidence-based practices in healthcare settings; especially those mostly frequented by such a population. Evaluation and research are warranted to arrive at effective standards of care within healthcare settings that are survivor-informed.
1.6. Theory and Framework
For this study, a theoretical framework was utilized not only to understand the complexities of the victimization resulting from ST, but also for its analysis. Intersectionality
theory focuses on understanding the complexities of the societal structures of inequality at multiple levels in conjunction with the experiences of individuals in their everyday life [38
]. Additionally, this theoretical framework posits that categories defined by society at-large; for example, race, gender, sexual orientation, socioeconomic statuses, age, among others, intersect and impact its members at the micro-level [39
]. Within the context of this study, this framework is important in seeking to understand the recommendations of a cluster of survivors of ST in that their recommendations stem from their multiple social identities and lived experience. These personal experiences and traumas resulted from their daily abuse and interactions with their oppressors—traffickers and sex buyers, as well as judgmental and biased care received at the different healthcare settings, they accessed during their victimization process [26
Therefore, seeking to understand the experiences of survivors of ST can awaken the sense of awareness and openness to the wisdom derived from their lived experience. The ability to integrate their important recommendations for better healthcare practices and assessments when serving potential ST-patients in healthcare settings can help in the formulation of much needed holistic healthcare protocols and practices. Moreover, Intersectionality
theory is relevant to our understanding of the importance of their noted recommendations in that their experiences were contextualized by a range of interconnections of oppression including, but not limited to racism, sexism, misogyny, xenophobia, classism, heterosexism, economic discrimination, inequities, and so on. Thus, the recommendations presented in this study are a result of these junctions. Most importantly, the voices of these survivors of ST can inform daily practices for healthcare professionals and other frontline personnel in order to create a care that is grounded in the proposed framework here presented—Compassionate Care
, along with the other principles of trauma-informed care [6
Lastly, the definition of health established by the World Health Organization’s constitution is an essential blueprint when addressing the needs of vulnerable populations such as trafficked-patients and others who need specific care beyond the presented acute physical and chronic needs. This definition states that health is not only the absence of infirmity, but “is a state of complete physical, mental and social well-being” [41
]. This definition along with a holistic approach to care must be applied when interpreting the findings of this study. It is essential to adhere to a holistic approach when identifying and addressing the needs of patients who have fallen victims to traffickers because they have developed multiple healthcare needs beyond the physical care [3
2.1. Sampling of Participants
This qualitative exploratory study utilized an a priori sampling approach widely used in public health to gain a greater understanding about participants’ perspectives and experiences of a given subject [42
]. To maximize sampling variation, data were collected across two major cities of the US. Study participants (N
= 22) (see Table 1
) were recruited via convenience sampling through victim-centered social service agencies, including survivor leaders’ organizations. These metropolitan cities constitute locations where HT activity has been documented—San Diego, CA, and Philadelphia, PA [43
2.2. Geographic Regions of the Study—San Diego, CA, and Philadelphia, PA
San Diego, CA, is the eighth largest city in the US and is located on the coast of the Pacific Ocean, in Southern CA, immediately adjacent to the Mexican border. Therefore, its proximity to Mexico creates an even greater vulnerability for victims of HT. Compared to other states in the West and Southwest regions of the US, CA ranks as the highest state in terms of HT reported cases to the US National Human Trafficking Hotline [45
]. According to the San Diego County District Attorney [46
], San Diego places 13th nationally for sex trafficking of minors. Recent research confirms that San Diego has indeed a greater likelihood of documenting higher estimates of ST than previously estimated with trafficking activity reported throughout the county [43
Although Philadelphia, PA, is not an international border city, it contains highways connecting the Northeastern and the Mid-Atlantic regions of the US. Thus, Philadelphia is considered by the anti-trafficking community advocates as a transit state given its easy interstate highways connections. Stakeholders who supported this project represented social service providers. In Philadelphia and surrounding metropolitan areas, these organizations included the following: Project Dawn’s Court, The Valley against Sex Trafficking (VAST), The Institute to Address the Commercial Sexual Exploitation at Villanova University Charles Widener School of Law, and the Women Organized Against Rape (WOAR). In San Diego, CA, supporting organizations consisted of Freedom from Exploitation, GenerateHope, Hidden Treasures Foundation, Soroptimist International of Vista and North County Inland, and Survivors for Solutions. These organizations were essential in sharing information about this study with their networks of survivors. If prospective participants were interested, they would then contact the researcher to set up a conveniently arranged meeting with the participant to ensure eligibility.
2.3. Safeguards for Identity Protection
This research was approved by Drexel University’s Institutional Review Board (IRB ID: 1602004287). Stakeholders and survivor-leaders also reviewed and approved the study’s interview guide prior to inviting members of their survivor-networks to participate in the study. All participants were provided a consent form explaining the study’s purpose and voluntary participation. To protect the identity of participants, consent was given verbally. Each participant also was able to choose their own pseudonym assigned to their data file. Additionally, each interview was assigned a unique identifier composed of letters and numbers (e.g., S345, P965, etc.). With these identity protective measures, there was no way to identify participants. Additionally, study participants provided their pseudo names at the end of the interview.
2.4. Eligibility Criteria
The eligibility criteria consisted of the following qualifications: (a) self-identified survivor of ST within the US; (b) visited healthcare settings during their trafficking experience; (c) were 18 years of age or older; (d) were able to read, write, and speak English; and (e) left their victimization at least six months prior to their participation in the study. The definition of survivor used in this study meant that all study participants were no longer being forced into commercial sexual exploitation, in the context of ST, and were emotionally ready to participate in the study.
2.5. Data Collection
This study’s data collection occurred between March 2016 and March 2017. Study participants were interviewed face-to-face or over the phone when necessary. Interviews were digitally recorded. Digital recordings were kept in a password-secured laptop. Semi-structured in-depth interviews lasted between 30–60 minutes. Participants also received a $30 gift certificate redeemable at local stores. At the end of the interview, participants chose their pseudo names. Participants’ pseudo names were used throughout the analysis.
2.6. Data Analysis
In-depth semi-structured interviews were transcribed verbatim. Transcriptions were then uploaded into a data management system—NVivo Mac version 11.4.0 (QSR International, Melbourne, Australia). The data were analyzed using an inductive thematic approach, including a five-step analysis process—reading, coding, displaying, collapsing, and interpreting [42
]. Through the first steps, emerging themes were identified, and open-ended codes were also created. This permitted the enumeration of a range of themes with ample detail in each of those identified. Afterwards, this information was reduced to important points within each theme. Throughout these steps, researchers sought to focus on the meaning of what participants shared during the course of the study’s semi-structured interviews. During the last step, data analysts provided an overall interpretation of the identified themes, and how these were connected with one another. Investigators worked independently to code text files for data analysis, and collectively shared their observations about essential points of each theme and their connection with one another. Lastly, they arrived at a consensus in their interpretation of data. Interpretations of data were subsequently triangulated through revisiting some of the research participants’ responses during early phases of the data analysis. The main themes identified were as follows: (1) Red Flag identification, (2) suggestions on how to care for patients of ST in the healthcare setting, and (3) types of resources that could assist ST-patients.
The findings of this study indicate that despite the immense challenges to identify potential ST-patients in the healthcare setting, there are potential Red Flags that could be observed and acknowledged by healthcare providers in the course of their daily responsibilities. The results of this study also confirm other researchers’ findings focused on the importance of compiling possible Red Flags
among ST-patients [6
]. Most importantly, this study’s findings are based on the survivors’ voices and their experiences during their trafficking victimization period. It is important to note that study participants caution healthcare providers to be aware of their personal biases and from stereotyping potential ST-patients. Someone could be trapped in this type of atrocity; however, the Red Flags may not be so visible.
In terms of supportive practices
that healthcare settings and providers need to explore and potentially adopt, this study points to important recommendations specific to attitudes related to the personal treatment of the ST-patient, creating a safe and comfortable environment, and practicing a type of care that adds to extant frameworks including trauma-informed
care—a Compassionate Care
. Additionally, withholding judgment about the ST-patient, demonstrating respect when taking a medical history and/or asking probing questions, and being aware of one’s personal biases must be reflected in the institutions’ culture, as well as in the healthcare providers’ daily practices. Moreover, these practices always warrant being subsumed within both trauma-informed
approaches to care, as well as being part of the healthcare providers’ medical ethos [25
]. Nonetheless, this study introduces the concept of Compassionate Care
in the context of caring for ST-patients. To the authors’ understanding, this concept has yet to be identified as a finding in previous literature in the context of HT. Compassionate Care
outside of the HT literature is defined as a type of care mainly provided by healthcare professionals, characterized by recognizing, understanding, and empathizing with the patient’s concerns suffering or pain. However, it does not stop there. The ability to empathize with the patient can move the healthcare provider to positive actions that typically lead to ameliorating the situation of their patient. Thus, healthy provider-ST-patient partnerships can potentially promote autonomy and self-efficacy in both providers as well as in their patients. This Compassionate Care
approach to care seems to offer the potential for additional positive outcomes in the context of the provider–patient relationship, as well as the patients’ health outcomes [52
]. This approach and applied skill to the care of ST-patients has the potential to facilitate a breakthrough in their interaction, assessment of needs, and provision of suitable resources for paving a successful exit from their oppression. A Compassionate Care
approach could also be applied to other vulnerable patients that frequent healthcare settings. In other words, it is not limited to only ST-patients, but any other vulnerable population that visits the healthcare setting and whose needs may overlap with trafficked victims.
For example, since Compassionate Care shows that the provider is willing to go the extra mile to ensure the ST-patient knows the provider cares for her, it could encourage them to perceive healthcare and the healthcare setting as a potential advocate and safe haven, respectively. If identified ST-patients could begin to trust the healthcare provider, there might be a window of opportunity to instill hope in their mind. This hope could lead the victim to be encouraged about receiving support and to leave her perpetrator. The recommendations of survivors are not only intended to better identify ST-patients in the healthcare setting, but also to identify key elements necessary to build trust between the patient and the provider. Without Compassionate Care, the identification of and opportunity to assist victims of sex trafficking in the healthcare setting is limited.
Once the healthcare provider has gained efficacy in learning how to identify Red Flags, and types of extant resources, information provided to such patients is just as essential as using the framework of compassionate care. This study highlights the importance of having a well-developed plan and knowledge of suitable local and national resources and partners needed to support this population. If the ST-patient is ready to leave her trafficker, the healthcare provider and the healthcare team must be ready to respond to her immediate needs as well. In cases where ST-patients are willing to share their status and are ready to leave their current situation, this study found a great need for a plan that ensures immediate protection and integrated support. If a protocol or plan is not in place, there are limited opportunities to assist ST-patients further. It is understandable that resources for patients who have been identified as victims of ST can be challenging to find; especially in this current strained healthcare system of the US. This is why a collaborative
model to assist and address the needs of ST-patients is essential in anti-trafficking efforts, as earlier stated [6
Additionally, types of information displayed, and its formatting are essential as well. Having posters displayed at the healthcare setting for everyone to see not only shows institutional awareness of the problem, but may simultaneously encourage this population to begin trusting this particular healthcare setting. Having resource-rich information disseminated to the ST-patients that is hidden from perpetrators is also important for their safety and the future opportunities for their return to the same medical setting. These recommendations point to the imperative of prioritizing the eradication of HT by implementing creative ways to address their condition. ST-patients live in constant danger under the oppression of their traffickers. The ultimate goal, therefore, is to keep her safe, build rapport and trust in the context of patient–provider interaction, and to offer opportunities for future intervention so that she can exit her victimization successfully.
Lastly, if a trauma-informed, victim-centered and Compassionate Care framework can be implemented, it would be fitting for healthcare settings to set up a peer-to-peer counseling system. Through this system, identified victims could be further assisted by peers whom they could find trustworthy given their similar victimization experience. This would not only reflect a victim-centered approach to care, but it will also allow for the integration of fellow survivors in the future intervention of other ST-patients. This approach to care seems to result in a two-fold outcome. First, it seeks to facilitate a greater prospect for building trust and rapport with the ST-patient. Second, it could also empower other survivors as they assist in the process of intervention. Showing ST-patients that the healthcare provider is someone who cares and is willing to go the extra mile by listening to the ST-patient with empathy offers the potential to build rapport, trust, and provide a more integrated process through the framework of Compassionate Care. These are vital components for assisting and supporting such a population in healthcare settings, including similar interactions with other frontline personnel.
4.1. Future Recommendations
Future research and evaluation are needed on how to better incorporate the HT signs, language and symbols into healthcare settings that can lead to inclusion, safety, and better outcomes for diverse HT survivors with multiple social identities. It is important to examine whether and how the content is physically displayed in and disseminated by healthcare facilities in a way that reflects diverse racial, ethnic, gender, and sexual orientation identities of all those who are victims of HT. More insights are needed about the effectiveness of these best practices.
Moreover, incorporating and evaluating training that includes the understanding of victims’ psychological trauma, as well as traffickers’ strategies for controlling their victims, are critical to creating trauma-informed and victim-centered care systems. They are essential not only to identify potential victims, but also to improve current intervention efforts. Most importantly, evaluation of medical care that is framed within the context of Compassionate Care towards the ST-patient could provide insights about the impact it might have on ending victims’ oppression and life-threatening circumstances of abuse and violence.
Future research could also gather more recommendations from survivors in other non-clinic-based health settings such as within the mental health and behavioral healthcare systems. In the current study, only one survivor spoke about a mental health system, but survivors do interact with social workers in other systems who could serve as first responders as well. Furthermore, findings from this study indicate a need to increase the systematic ways to track ST-patients in the healthcare setting into a national database. A national database would assist given the migratory nature of some trafficking rings where victims of ST are moved from state to state. Overall, more research is needed to inform best practices for the early identification and detection of HT; specifically, when applying the framework of Compassionate Care to this vulnerable population.
4.2. Limitations and Strengths
This study relied on a convenience, non-random sampling technique for recruitment of participants, which consequently limits the generalizability of its findings to the nation’s population. Thus, findings derived from this study may not represent the experiences identified by individuals across other regions of the US, or those residing in non-metropolitan areas. Similarly, the same limitations emerge relative to victims of HT who are foreign nationals and residing in the US. Because this study was derived from a small sample, generalizability is therefore limited, especially given extant contextual and environmental considerations. The conclusions derived from this study, however, relied on the lived experiences of a cluster of female US-born victims of HT, and their prior interactions with healthcare providers in various types of healthcare settings within two of the nation’s top 10 largest metropolitan areas. Nonetheless, small and localized samples are generally considered a hallmark of qualitative research, which confers advantages such as the ability to iteratively respond to emergent themes and concepts as the research evolves, and the ability to provide textured narrative description yielding insight into processes, meanings, and social dynamics [53
Another limitation in this study could be recall bias. The study’s participants relied on their ability recalling events during prior interactions with healthcare providers which could potentially lead to inaccuracies, including recall bias of detailed information about their prior victimization. However, securing their participation from two geographically diverse regions of the US, and incorporating two types of data sets, qualitative and quantitative, enhances the potential to increase the validity of the study’s findings. Moreover, having designed and tested a semi-structured interview guide prior to initiating this study, comprising questions that were clear to the study participants in conjunction with relying on an experienced and well-trained interviewer, would also appear to reduce the potential for recall bias.
Additionally, similar to other research about sensitive topics when working with a hidden and vulnerable population, considerations of social desirability bias may be applicable. Some study participants might have minimized their responses of what they perceived to be undesirable behaviors or attitudes when questioned by their healthcare providers. However, given the high amount of saturation on the topic achieved in the current analysis, we judge these threats to be minimal.
This study sought to understand the significance of the narratives and views of a cluster of ST survivors, including their recommendations for healthcare providers who are uniquely positioned to identify and intervene on their behalf while delivering medical care to them. Unfortunately, their perspectives are frequently absent in the research literature, despite the fact that this hidden population often experiences persistent trauma, stigma, marginalization, racism, and sexism, among many other forms of oppression. This study identified recommendations that can inform healthcare providers’ critical decision-making processes in identifying, intervening, and providing suitable resources on behalf of ST-patients to move beyond victimization. These findings suggest a need for implementing specific education on how to identify potential Red Flags; understand personal assumptions, stigma, and biases about and toward ST-patients, and suggestions for supportive practices in order to best care for such a population in the healthcare system. These recommendations from survivors of ST aim to build rapport and trust, thus assisting in the process of exiting their victimization by offering suitable trauma-informed and patient-centered approaches of care. Specific resources that can be useful for ST-patients include the following: (a) peer-counseling, (b) displayed posters in the lobby or waiting rooms, and (c) discrete information given during their clinical appointment, without the knowledge of the trafficker. Thus, healthcare providers can play a positive role by creating physical environments and survivor-informed practices and protocols that are welcoming, provide for their safety and build trust and rapport with potential ST-patients.