Written by Emily A. Cheslock

Human trafficking is occurring in every corner of the world, including Texas. This crime disproportionately impacts the most vulnerable among us. Traffickers exploit victims – often, children, minorities or immigrants – for economic gain.

A 2016 study from the University of Texas at Austin estimates there are 300,000 human trafficking victims in Texas. The study identifies 79,000 victims of sex trafficking and 234,000 victims of labor trafficking. But this only represents a fraction of the real numbers. Human trafficking, by its nature, makes data challenging to ascertain.

In a statement to the Texas Legislature, the Texas Human Trafficking Prevention Taskforce noted that “collecting accurate human trafficking data is difficult. This challenge makes the scope of trafficking across the state difficult to understand.”

chart of human trafficking cases reported in Texas, by year

What is known is that Texas is one of the top three states for human trafficking, joined by California and New York. This number is only rising. Cases reported to the National Human Trafficking Hotline more than doubled between 2015 and 2019.

The National Human Trafficking Hotline connects victims with support and services to get help and stay safe. The hotline also uses non-personally identifying information to produce public reports. The reports contain aggregate statistics based on region, trafficking type and demographics. This data helps identify trends and patterns that can help inform prevention and intervention efforts at local, state and national levels.

According to the American Hospital Association, these statistics provide a useful view of national and local insights based on cases reported.

Laura Castellanos
Castellanos

“We advise caregivers to ask victims to call in to the National Human Trafficking Hotline. The best data we have on likely sex and labor trafficking comes from that hotline. Contacting the hotline helps us to see trends, prevalence and connect the victims to resources,” said Laura Castellanos, associate director and staff lead for the Hospitals Against Violence initiative at AHA.

Hospitals and health care providers play a critical role in the fight against human trafficking. A study from the Annals of Health Law estimates that 87% of trafficking victims had contact with a health care provider while being trafficked. This statistic highlights the need for health care providers to know how to spot human trafficking signs.

Kimberley Williams
Williams

“Victims may be hesitant to seek help and are less likely go to law enforcement,” said Kimberley Williams, director of the anti-human trafficking program at Baylor St. Luke’s Medical Center in Houston. “But they will seek medical care. When they come to the hospital, that is one of the very few opportunities that victims are away from their trafficker or that we can separate them from their trafficker. We can help them get care and support.”

Identifying Victims

Once hospitals increase awareness internally that human trafficking is an issue in their community, they can begin to better understand how to identify victims. While some red flags are easy to spot – unexplained bruising, a lack of documentation or identification, someone else answering questions for them – some are more subtle and require training and experience.

image of a patient in a hospital bed

“Victims may be hesitant to seek help and are less likely go to law enforcement. But they will seek medical care. When they come to the hospital, that is one of the very few opportunities that victims are away from their trafficker or that we can separate them from their trafficker. We can help them get care and support.”

KIMBERLEY WILLIAMS, DIRECTOR OF THE ANTI-HUMAN TRAFFICKING PROGRAM AT BAYLOR ST. LUKE’S MEDICAL CENTER

“We want to empower our staff to identify victims and to support survivors on the road to recovery,” Williams said. Health care providers can be instrumental in supporting victims. Education and training are two of the most important steps in helping professionals recognize victims in the hospital setting.

Baylor St. Luke’s requires all employees to participate in human trafficking training. They offer both online and face-to-face education. In these sessions, participants work through case studies to help fine-tune their skills in identifying red flags. Baylor St. Luke’s invites survivors of human trafficking to share their stories to help providers learn to spot the more subtle signs of trafficking.

AHA advises that if hospital leaders want to put training and protocols in place, they should begin by looking at their hospitals’ department-level anti-violence efforts. Often there will already be efforts underway or protocols in place.

“Once leaders identify what is already in place, they can start looking at ways to coordinate among different departments. This can include interdisciplinary committees, awareness campaigns and leadership support,” Castellanos said.

Williams also expressed the importance of having protocols in place across hospitals and health care systems within the community. “We know that there are many victims in our community. Even if we identify five to 10 victims per week, we are still missing quite a few every day. That’s why we need every health care provider in our community to know what to look for.”

The Houston Area Human Trafficking Healthcare Consortium is a group of health care providers committed to raising awareness, providing education and collaborating to prevent human trafficking. The goal of the consortium is to increase the continuum of care for human trafficking victims within the greater Houston area.

“We have providers from the Texas Medical Center and beyond who participate in our monthly meetings where we discuss best practices and protocols to help providers increase care for patients. The consortium creates an environment where the health care system becomes an ally with the patient,” Williams said.

Castellanos echoes the importance of collaboration to enhance training opportunities and create consistent protocols. “Simply put, we’re missing opportunities. About two-thirds of survivors report they came through the health care system and were not identified. It’s so important to understand the necessity of collaboration, education and training.”

image of mother and daughter on a hospital bed, hugging

“Hospitals need to know that they’re not alone in this work. There is a lot of community support, and it’s critical to band together to help victims recover.”

LAURA CASTELLANOS, ASSOCIATE DIRECTOR AND STAFF LEAD FOR THE HOSPITALS AGAINST VIOLENCE INITIATIVE AT AHA

Creating Community Partners

It is not enough for a health care provider to simply identify a victim of trafficking. Hospitals and health care providers need to provide resources to help victims begin the healing process. “If we identify a victim in the hospital, provide acute care, and then discharge back into the hands of a trafficker, we’ve done the patient a disservice. Our goal is to not only identify but also to ensure that we discharge patients into safe hands,” Williams said.

Hospitals are working to create partnerships in their communities. These partnerships are meant to ensure that a continuum of care plan is in place for victims. The Houston Area Human Trafficking Consortium has relationships with homes that provide long-term care or housing for trafficking victims. These homes offer a safe and comfortable place for victims to stay while on the road to recovery.

“Hospitals need to know that they’re not alone in this work. There is a lot of community support, and it’s critical to band together to help victims recover. There are many sex and labor trafficking survivors in communities that can help caregivers be trauma-informed, understand how to handle cases and provide victims with the support they need,” says Castellanos.

There are many community options that provide additional support to hospitals by caring for victims. Faith-based organizations bring well-developed networks, strong community trust and long-standing expertise serving refugees, violence victims and other populations in need. Studies also show that faith-based care allows victims to let their guard down and learn to trust someone again.

“When trafficking starts, for many victims, they initially trusted someone, but soon realized they were tricked, deceived or manipulated. They found themselves unable to escape because of the force, fraud and coercion used to keep the person confined. Some feel an enormous amount of shame – they ask, ‘How could I have been duped like this?’ or ‘How can I tell my family what happened?’ Faith-based organizations give a foundation of support and care for survivors,” Williams said.

New Law Empowers Providers

In September of 2020, Texans who work in health care-related professions regulated by the state began mandated training to spot the warning signs of human trafficking. This new requirement stems from House Bill 2059 – a bill aimed at empowering health care workers to prevent human trafficking in their communities.

House Bill 2059 – sponsored by Rep. Cesar Blanco (D-El Paso), Sen. Larry Taylor (R-Friendswood), Sen. Carol Alvarado (D-Houston) and Sen. Eddie Lucio (D-Brownsville) – passed with bipartisan support during the 2019 Texas legislative session.

Jennifer Banda
Banda

“Rep. Blanco came to us because he wanted to pass a bill that would require human trafficking training for all health care providers. We worked with him, hospital leaders, doctors, nurses and everyone else on the bill to ensure that it would be feasible for hospitals and care providers to get the training they needed,” said Jennifer Banda, J.D., vice president of advocacy, public policy and political strategy at the Texas Hospital Association.

The bill requires anyone who provides patient care in a medical facility to be trained in the identification of human trafficking as part of their licensure. The Texas Health and Human Services Commission must approve the training programs and at least one program must be offered by HHSC, at no cost to the health care provider. The approved programs are listed on HHSC’s website.

Text from House Bill 2059, Direct care providers in a medical facility must be trained in the identifaction of human trafficking as part of their licensure

“This bill was huge. We really thought it was going to take multiple tries. But there was so much support and focus on human trafficking and sexual assault that session that it sailed right through,” said Banda.

Human trafficking is an issue that continues to be prevalent in Texas and around the globe. Hospitals, community organizations, government agencies, law enforcement and lawmakers continue to work together to address this public health crisis. Through education and collaboration, Texans can put an end to human trafficking and help victims on their road to recovery.