Screening to Identify Trafficking Survivors

Screening to Identify Trafficking Survivors


>GOOD AFTERNOON EVERYONE. THANK YOU FOR JOINING US FOR THE AFTERNOON
SESSION. I’M NICOLE GREENE CURRENT ACTING DIRECTOR
OF THE OFFICE ON WOMEN’S HEALTH AND DEPUTY DIRECTOR OF OFFICE OF WOMEN’S HEALTH. AT THE U.S. DEPARTMENT OF HEALTH AND HUMAN
SERVICES. I’M THRILLED TO PARTICIPATE IN THIS ANNIVERSARY
SYMPOSIUM AND MODERATE THIS PANEL SESSION PRESENTATION SCREENING TO IDENTIFY TRAFFICKING
SURVIVORS. HUMAN TRAFFICKING HAS BEEN PART OF THE WORK
OF OWH FOR MANY, MANY YEARS, WE’RE PLEASED TO COLLABORATE WITH OUR FEDERAL PARTNERS TO
CONVENE THIS ANNIVERSARY SYMPOSIUM. BEFORE I INTRODUCE OUR PANELISTS, I WANT TO
SHARE OUR OFFICE AND HOW WE BECAME INVOLVED IN ANTI TRAFFICKING INITIATIVES. THE MISSION OF THE OFFICE ON WOMEN’S HEALTH
TO IMPROVE HEALTH AND WELLNESS OF WOMEN AND GIRLS ACROSS THE NATION. WE DO THIS TRUE POLICY, EDUCATION, AND INNOVATIVE
PROGRAMS. WE DO THIS BY INFORMING AND INFLUENCING POLICY,
EDUCATING THE PUBLIC AND PROFESSIONALS AND DEVELOPING INNOVATIVE PROGRAMS THAT FILL GAPS
IN PRIMARY, SECONDARY AND TERTIARY PREVENTION. HUMAN TRAFFICKING IS A PUBLIC HEALTH ISSUE. AND ONE THAT IMPACTS MANY VULNERABLE CROSS
CUTTING POPULATIONS INCLUDING WOMEN AND GIRLS. SINCE 2013, WE’VE PARTNERED WITH ADMINISTRATION
FOR CHILDREN’S AND FAMILIES OFFICE ON TRAFFICKING AND PERSONS OTIP TO STRENGTHEN CROSS DEPARTMENTAL
INITIATIVES TO SUPPORT SERVICES AND PREVENT HUMAN TRAFFICKING. OUR SIGNATURE EFFORT
TRAINS HEALTH CARE PROVIDERS AND SOCIAL SERVICE PROVIDERS TO IDENTIFY AND RESPOND TO HUMAN
TRAFFICKING. THIS YEAR SYMPOSIUM HELPS US LEARN MORE ABOUT
PREVENTION, SCREENING, IDENTIFICATION AND SUPPORT SERVICE RECOMMENDATIONS FROM AN ARRAY
OF DIVERSE PERSPECTIVES IN THE ANTI TRAFFICKING COMMUNITY INCLUDING THOSE WITH LIVED EXPERIENCES. WE’VE HEARD TODAY FROM EXPERTS REGARDING PREVENTION
STRATEGIES, AND INTEGRATION OF HEALTH SERVICES. NOW WE WILL FOCUS ON IDENTIFICATION AND SCREENING
TOOLS, AND STRATEGIES TO INCORPORATE REFERRAL PROTOCOLS FOR SURVIVORS TO OBTAIN RESOURCES
AND SUPPORT THAT THEY NEED. THEREFORE, I’M PLEASED TO INTRODUCE THE EXPERTS
ON THIS PANEL WHO WILL GUIDE US THROUGH THIS INVALUABLE DISCUSSION ON SCREENING CONSIDERATIONS. FIRST, DR. WENDY MACIAS KONSTANTOPOULOS, A PRACTICING
EMERGENCY PHYSICIAN AT MASSACHUSETTS GENERAL HOSPITAL AND ASSISTANT PROFESSOR OF EMERGENCY
MEDICINE AT HARVARD MEDICAL SCHOOL. NEXT SPEAKER DR. MAKINI CHISOLM STRAKER AND MARY LANDERHOLM,
FOLLOWED BY ANNA MARJAVI FROM PROJECT CATALYST BASED IN SAN FRANCISCO, CALIFORNIA. AND FINALLY VALERIE DOUGLAS, THE DIRECTOR
OF THE COUNSELING AND RUNAWAY AND HOMELESS YOUTH SERVICES AT THE CENTER FOR YOUTH SERVICES
IN ROCHESTER NEW YORK. THIS PANEL WILL EXPLORE DEFINING SCREENING,
SECOND TO EXPLORE FOUNDATIONAL PRINCIPLES SUPPORTING TRAUMA INFORMED SCREENING AND FINALLY
TO SHARE LESSONS AND GAPS IN KNOWLEDGE, OBSERVED FROM WORKING WITH PARTICULAR POPULATIONS. MANY INDIVIDUALS WHO HAVE EXPERIENCED TRAFFICKING
COME INTO CONTACT WITH PROFESSIONALS DURING AND AFTER EXPLOITATION. YET REMAIN UNIDENTIFIED. SCREENING IS A CRUCIAL STEP TO THE EFFECTIVE
RESPONSE ALLOWING SURVIVORS TO BE CONNECTED WITH RESOURCES AND ASSISTANCE. HOWEVER, SCREENING PROCESSES CAN RETRAUMATIZE
AND PREVENT A UNIQUE SET OF CHALLENGES IF TECHNIQUES ARE NOT TRAUMA INFORMED. IN THE REALM OF PUBLIC HEALTH, THE PURPOSE
OF SCREENING IS NOT TO PUSH FOR DISCLOSURE BUT TO BETTER SERVE THE NEEDS OF TRAFFICKED
INDIVIDUALS. ADDITIONALLY, THERE’S NO SINGULAR OR UNIVERSAL
HUMAN TRAFFICKING EXPERIENCE. THERE ARE MANY FACTORS THAT MUST BE CONSIDERED
TO ENSURE THE POTENTIAL SURVIVORS FEEL SUPPORTED. SCREENING PROCESSES SHOULD BE ADAPTABLE, AND
INFORMED BY KNOWLEDGE OF LOCAL RESOURCES AVAILABLE TO TRAFFICKED INDIVIDUALS. IN THEIR UPCOMING PRESENTATIONS, PANELISTS
WILL DRAW FROM EXPERIENCES WORKING WITH TRAFFICKED INDIVIDUALS TO EXPLORE COMPLEXITIES OF SCREENING. DR. MACIAS KONSTANTOPOULOS WILL KICK THINGS OFF
ON IMPORTANCE OF TRAUMA INFORMED DESCRIPTION. DR. CHISOLM STRAKER WILL TALK ABOUT WHAT SCREENING
LOOKS LIKE IN A HEALTH CARE SETTING. MARY LANDERHOLM WILL TALK ABOUT EXPERIENCES
HELPING AN ORGANIZATION THINK ABOUT HOW TO SCREEN FOR TRAFFICKERS AND TRAFFICKING IN
VICTIMIZATION. AND ANNA MARJAVI WILL TALK ABOUT APPROACHES
AND VALERIE DOUGLAS WILL TALK ABOUT RUNAWAY YOUTH AND APPROACHES EVOLVED OVER TIME. I’LL TURN IT OVER TO DR. MACIAS KONSTANTOPOULOS AND WE’LL DIVE RIGHT
IN.>>THANK YOU VERY MUCH FOR HAVING ME TODAY. AND FOR THE VERY WELL PRONOUNCED LAST NAME,
FROM HERE ON YOU’RE ALLOWED TO SAY MACIS K. THANK YOU TO HHS FOR THE YEARS THEY DEDICATED
TO THE ISSUE AND SHINING THE SPOTLIGHT ON HEALTH AND PUBLIC HEALTH ISSUES RELATED TO
TRAFFICKING. I WANT TO THANK THE OTIP, OFFICE OF TRAFFICKING
IN PERSONS, THE TEAM THAT’S BEEN EXTREMELY SUPPORTIVE OF EFFORTS THAT ARE GOING ON, ON
THE GROUND. AND THAT IS CRITICAL TO MENTAL HEALTH AND
HEALTH CARE PROVIDERS AND SOCIAL SERVICE PROVIDERS TO BE ABLE TO CONTINUE IN THIS WORK, AND TO
FIND WAYS AND INNOVATE HOW WE PROVIDE OUR CARE. FINALLY TO LEADERSHIP AT MASSACHUSETTS GENERAL
WHERE I WORK FOR THEIR SUPPORT IN THE LAST TEN YEARS OF THE MASS GENERAL HUMAN TRAFFICKING
INITIATIVE, THROUGH WHICH WE WORK ON ANTI TRAFFICKING EFFORTS AND RESEARCH AREAS AND
CLINICAL CARE THROUGH THE MGH FREEDOM CLINIC. IN THE BRIEF TEN MINUTES I HAVE TO SPEAK WITH
YOU I’M GOING TO COVER A LOT OF INFORMATION, THERE’S ONLY THREE SLIDES BUT IT’S PACKED
WITH INFORMATION. SOME OF THIS IS ALREADY KNOWN SO HOPEFULLY
IT WON’T BE NEWS TO ANYONE. BUT I WANT TO COVER PRINCIPLES OF TRAUMA INFORMED
CARE TO BEGIN WITH, PRINCIPLES OF A CULTURALLY RESPONSIVE APPROACH TO CARE AND FINALLY I’LL
END BY REITERATING WHAT I BELIEVE ARE SOME OF THE MOST IMPORTANT TAKE HOME MESSAGES RELATED
TO IMPLEMENTING THESE PRINCIPLES OF TRAUMA INFORMED AND CULTURALLY RESPONSIVE CARE AS
OUR MODUS OPERANDI IN OUR DAILY WORK. SO PRINCIPLES OF TRAUMA INFORMED CARE, BASICALLY
THERE’S A SLIDE FOR THIS. TRAUMA INFORMED CARE REALIZES THAT TRAUMA
INFORMED IS WIDESPREAD, AND THAT IT HAS PROFOUND IMPACT ON OUR HEALTH AND WELL BEING. SO WE NEED TO UNDERSTAND TRAUMA IS UBIQUITOUS
AND EVERY PERSON AT SOME POINT DURING THEIR LIFESPAN WILL EXPERIENCE SOME DEGREE OF TRAUMA. AND HEALTH CARE PROFESSIONALS, OR SOCIAL SERVICE
PROVIDERS, SOMETHING WE NEED TO CARRY IN OUR DAILY WORK MEETING WITH PATIENTS AND CLIENTS. RECOGNIZING SIGNS AND SYMPTOMS IS IMPORTANT,
OUR PATIENTS SHOULD NOT HAVE TO SPELL OUT WHAT THEIR TRAUMA IS. IN FACT, WE NEED TO BE AWARE THAT OF THE CUES
THEY PROVIDE US, TO EITHER BACK OFF FROM A LINE OF QUESTIONING OR LINE OF CONVERSATION,
OR MOVE FORWARD WITH THAT OR SIT WITH THEM COMFORTABLY IN THE SILENCE THAT PROVIDES THEM
THEIR SENSE OF SAFETY. INTEGRATE KNOWLEDGE ABOUT TRAUMA INTO POLICIES
AND PROCEDURES AND PRACTICES, SO IF WE’RE FULLY TRAUMA INFORMED, THESE CONCEPTS AND
PRINCIPLES NEED TO PERMEATE EVERY ASPECT OF THE CARE THAT WE PROVIDE, EVERY THREAD OF
THE TAPESTRY IN OUR CARE. OUR POLICIES, PROCEDURES, PRACTICES MUST BE
INFORMED AND TAILORED TO FOSTER AND SUPPORT RECOVERY AND SURVIVORSHIP. SO WHAT DOES THAT LOOK LIKE? JUST DRAWING FROM SOME OF THE CONCEPTS THAT
WE RELY ON AT OUR CLINIC, AT THE MASS GENERAL FREEDOM CLINIC, FOR EXAMPLE, WE LEAVE AMPLE
TIME FOR PATIENT CARE, IT’S NOT THE 20 MINUTE APPOINTMENT THAT TRADITIONALLY WE’RE USED
TO. THESE ARE LONGER APPOINTMENTS BECAUSE WE REALIZE
SOMETIMES THE MOST IMPORTANT NEEDS AND REQUESTS FROM OUR PATIENTS WILL COME AT THE VERY END,
ONCE THEY HAVE WARMED UP AND THEY FEEL MORE COMFORTABLE IN THE SETTING. SO WE LEAVE AMPLE TIME FOR THAT. WE LIMIT THE NUMBER OF PROVIDERS, SO THAT
OUR PATIENTS HAVE LONG TERM CONSISTENCY ACROSS THEIR CARE. WE DON’T CHASTISE FOR MISSING APPOINTMENTS. WE UNDERSTAND THAT THAT MISSED APPOINTMENT
AND DISENGAGEMENT FROM TIME TO TIME IS PART OF THE RECOVERY PROCESS, AND IT’S PART AND
PARCEL OF WHAT WE DO. AND WE NEED TO SUPPORT RATHER THAN CHASTISE
THEM THROUGH THOSE PERIODS OF TIME. WE REACH OUT TO THEM FOR CHECK INS.
AND MAKE OURSELVES AVAILABLE TO OUR PATIENTS NEARLY 24/7, AS BEST AS WE CAN DURING DAYS
OF THE WEEK AND HOURS OF THE DAY THAT TYPICALLY PERHAPS WE ARE NOT TRADITIONALLY AVAILABLE
TO PATIENTS IN THE HEALTH CARE SYSTEM. THEN WE HAND PICK SOME OF OUR PROVIDERS. WE TRAIN THEM AROUND TRAUMA INFORMED CARE. AND REALLY SORT OF THOUGHTFULLY THINK ABOUT
WHO WILL RECEIVE OUR REFERRALS IN THE SUBSPECIALTY WORLD. AND WE VALUE AND INCLUDE SURVIVOR VOICES IN
OUR ADVISORY AND STEERING PRACTICES AS WELL. SO WE TRAUMA INFORMED CARE ALSO ACTIVELY STRIVES
TO MINIMIZE RETRAUMATIZATION IN OUR SERVICES. AND WE NEED TO ACKNOWLEDGE THE FACT THAT SOME
OF OUR CARE PRACTICES IN HEALTH CARE SYSTEM CAN BE PHYSICALLY OR EMOTIONALLY THREATENING,
TO OUR PATIENTS, AND WE NEED TO BE DELIBERATE ABOUT EFFORTS TO IDENTIFY THOSE AREAS OF IMPROVEMENT
AND ACTUALLY MAKE CHANGES FOR THE BETTER. SO NOT HOVERING OVER PATIENTS OR CLIENTS ASKING
QUESTIONS OF THIS, THERE WAS A CHECKLIST WE WERE TRYING TO CHECK OFF, OR IN ROTE LIKE
FASHION, RATHER ENGAGING IN CONVERSATION AT EYE LEVEL. NOT ABANDONING OUR PATIENTS IMMEDIATELY AFTER
THEY HAVE OPENED UP TO US IF THEY DO, YOU KNOW, SUDDENLY WE RUN OUT OF TIME AND HAVE
TO RUN. WE NEED TO STAY WITH THEM AND THANK THEM FOR
THEIR TRUST, VALIDATE THEIR EXPERIENCE, AND HELP THEM GET THROUGH THAT MOMENT OF PERHAPS
EMOTIONAL ESCALATION. AND NOT ASK QUESTIONS OUT OF CURIOSITY OR
OUT OF JUST SIMPLY WANTING TO KNOW BUT RATHER LIMITING THE QUESTIONS TO WHAT IS ABSOLUTELY
NECESSARY FOR THEIR CARE. IN TERMS OF SUPPORTING RECOVERY, WE NEED TO
SUPPORT THEIR SAFETY, RESPECT AND ACCEPTANCE, SO USING NON DESCRIPT WAYS OF MARKETING A
CLINIC MIGHT BE ONE WAY TO DO THAT. TRUST AND TRANSPARENCY IS CRITICAL TO THE
RELATIONSHIP. PEER SUPPORT AND SELF HELP, SEEKING OUT CARE
WHEN IT’S NEEDED, USING COPING HEALTHY COPING MECHANISMS AND DEESCALATING TECHNIQUES WHEN
TRIGGERED. COLLABORATING AND BEING MUTUALLY RESPECTFUL
OF EACH OTHER’S DECISIONS IS IMPORTANT SO SHARED DECISION MAKING IS AN IMPORTANT PROCESS
IN THE RECOVERY, UNDERSTANDING AND VALUING AND ELICITING THEIR GOALS AND THEIR PRIORITIES
IN THEIR CARE. AND THEN BEING RESPECTFUL OF CULTURAL HISTORICAL
AND GENDER ISSUES. THIS INCLUDES RECOGNIZING THAT BOYS, MEN AND
TRANSGENDER PERSONS CAN BE BOTH LABOR AND SEX TRAFFICKED. THE PRINCIPLES OF CULTURALLY RESPONSIVE APPROACH,
VALUING DIVERSITY AND INCLUSION, MAKING SURE THAT WE UNDERSTAND THAT WE’RE TAKING CARE
OF PEOPLE FROM ALL WALKS OF LIFE AND WE NEED TO BE RESPECTFUL OF THEIR BELIEFS AND THEIR
CULTURES AND NORMS. ACCEPTING RESPONSIBILITY FOR INVESTING IN
STRATEGIES TO DECREASE BARRIERS TO CARE, SO EVEN SOME PEOPLE HAVE BROUGHT UP THE ISSUE
OF LANGUAGE SERVICES, AND THAT’S REALLY IMPORTANT. IT’S ONE WAY AMONG MANY WE CAN DECREASE THOSE
BARRIERS. AND SO FINALLY SOME OF THE TAKE HOME MESSAGES
THAT I WANT TO REVIEW, THESE ARE A FEW OF MANY THAT WE COULD CHOOSE TO HIGHLIGHT, AND
TAKEN FROM SOME OF MY PERSONAL AND PROFESSIONAL EXPERIENCES WITH TRAUMA SURVIVORS, SCREENING
IS NOT A CHECKLIST. AND THE QUESTIONS SHOULD NOT BE READ OUT. IT SHOULD BE A CONVERSATION THAT WE’RE HAVING
WITH OUR PATIENTS AT THE PACE THEY GET TO SET. ONE SIZE FITS ALL SCREENING CAN DO HARM TO
OUR CLIENTS AND PATIENTS THAT WE NEED TO REMEMBER THAT EVERY EXPERIENCE IS DIFFERENT AND EVERY
INDIVIDUAL HAS THEIR PACE AT WHICH THEY FEEL COMFORTABLE DISCLOSING, IF AT ALL. SCREENING OR MORE ACCURATELY ASSESSMENT REQUIRES
ACTIVE LISTENING, AND NEED TO KNOW FRAMEWORK SO NOT ASKING QUESTIONS OUT OF CURIOSITY OR
JUST BECAUSE WE’RE INTERESTED BUT RATHER BECAUSE WE NEED TO KNOW TO PROVIDE THE SERVICES AND
CARE THEY NEED. BUILDING RAPPORT AND EARNING TRUST ARE CRUCIAL
COMPONENTS OF BEING ABLE TO SCREEN AND ASSESS. FOR MANDATED REPORTERS WHICH MOST OF US ARE,
TRANSPARENCY ABOUT THE LIMITS OF CONFIDENTIALITY IS REALLY IMPORTANT, ACTUALLY BEING UP FRONT
ABOUT THIS FROM THE VERY BEGINNING, NOT ONLY SENDS THEM A MESSAGE OF HOPE THAT MAYBE IT’S
NOT JUST YOU, MAYBE THERE IS A WHOLE LITTLE ARMY OF PEOPLE THAT CAN HELP ME, THAT ARE
BACKING YOU UP, BUT ALSO IT MINIMIZES THE CHANCE OF THERE BEING A RIFT IN THE RELATIONSHIP
LATER. IT ALLOWS THEM THE CHOICE TO TELL OR NOT TELL
YOU WHAT’S HAPPENING. AND MAKING SURE WE HAVE RESPONSE PROTOCOLS
AND THAT WE HAVE INFRASTRUCTURE OF COMMUNITY AND HOSPITAL BASED RESOURCES WE CAN REFER
OUR PATIENTS AND CLIENTS TO IS REALLY CRUCIAL BEFORE YOU EVEN START DOING ANY SCREENING
OR ASSESSMENTS. THANK YOU. [APPLAUSE]>>WHO DO I LOOK FOR FOR THE TIME? OKAY, THANKS. I’M MAKINI CHISOLM STRAKER, BASED OUT OF NEW
YORK, A CO FOUNDER OF HEAL TRAFFICKING, A DOC AT MOUNT SINAI IN NEW YORK CITY. BEFORE I MOVE FORWARD I NEED TO GIVE DISCLOSURE
THAT NOT ONLY DOES SINAI PAY ME BUT THE STUDY THAT I MAY OR MAY NOT TALK ABOUT IF WE HAVE
TIME IS FUNDED BY THE ROBERT WOOD JOHNSON FOUNDATION AND WAS PREVIOUSLY FUNDED BY THE
EMERGENCY MEDICINE FOUNDATION. THAT BEING SAID, MY JOB IS TO TALK ABOUT DEFINITIONS. THIS IS NOT MY USUAL TALK, THERE’S NOT PICTURES
IN MY SLIDES. BUT THAT’S BECAUSE WORDS ARE SO, SO IMPORTANT. LANGUAGE REALLY MATTERS. WE NEED TO BE VERY PRECISE IN THE LANGUAGE
AND WORDS WE USE, BECAUSE THE LANGUAGE REFLECTS WHAT WE THINK, WHAT WE BELIEVE AND HOW WE’LL
ACT. IF WE AS THE PROFESSIONALS AS THE EXPERTS
ARE NOT PRECISE IN HOW WE COMMUNICATE WITH EACH OTHER, THEN THAT REFLECTS, TO ME, POORLY
ON HOW WE’RE SERVING THE PEOPLE THAT WE SAY WE’RE TRYING TO BE OF SERVICE TO. THAT BEING SAID, THESE DEFINITIONS ARE THE
ONES THAT WE’RE SORT OF WORKING WITH TODAY. IF YOU HAVE ANOTHER DEFINITION, IT’S IMPORTANT
THAT YOU SAY THAT AT THE OUTSET SO WE’RE ALL SPEAKING A SIMILAR LANGUAGE AT LEAST. SO, THE FIRST ONE THAT I WANT TO DEFINE, THE
FIRST TWO, YOU HEARD DR. CHANG TALK ABOUT EARLIER TODAY. SHE SAID SCREENING AND ASSESSMENT TOGETHER
A LOT. SCREENING IS APPLIED TO PRE DETERMINED POPULATION
TO IDENTIFY THE POSSIBLE PRESENCE OF OUTCOME OF INTEREST. IT SOUNDS LIKE A LOT OF RHETORIC AND A LOT
OF HEDGING BECAUSE IT MOSTLY IS. BUT IT’S AN INSTRUMENT YOU’RE USING PURPOSEFULLY
TO A GROUP OF PEOPLE. THAT GROUP OF PEOPLE IS DEFINED AT THE BEGINNING,
BEFORE YOU DECIDE WHEN YOU’RE GOING TO USE IT. WE’LL TALK ABOUT WHY THIS IS IMPORTANT. THE GOAL IS TO NOT DIAGNOSE SOMEONE PER SE
BUT TO SEE IF YOU NEED TO DIG DEEPER, RIGHT? SO AN EXAMPLE IN THE EMERGENCY DEPARTMENT,
A PARTICULAR TYPE OF HEART ATTACK. IF YOU COME TO AN EMERGENCY DEPARTMENT AND
COMPLAIN OF CHEST PAIN YOU SHOULD BE GETTING AN EKG IN THE FIRST TEN MINUTES, IT’S A SCREENING
TEST. IT DOESN’T MEAN YOU DO OR DON’T HAVE A HEART
ATTACK PER SE, IT’S JUST ONE WAY WE WANT TO LOOK REALLY QUICKLY AND DECIDE DOES THIS PERSON
NEED FASTER MORE RAPID ASSESSMENT THAN OTHERS WHO COME IN WITH CHEST PAIN FOR THIS PARTICULAR
THING. DOESN’T MEAN YOU DON’T HAVE SOMETHING ELSE
BAD GOING ON, JUST MEANS THAT ONE THING WE’RE LOOKING FOR IN THIS WAY. THAT’S ONE EXAMPLE OF A SCREENING TEST. ASSESSMENT IS EVALUATION INSTRUMENT USED BY
AN EXPERT WHEN THERE IS A CONCERN FOR AN OUTCOME OF INTEREST. IT DOESN’T HAVE TO BE AN INSTRUMENT PER SE. BUT ASSESSMENT IS USED BY AN EXPERT, IT REQUIRES
AN EXPERT, OKAY? IT MEANS THAT YOU CAN’T JUST WALK IN OFF THE
STREET AND, OH, I’M GOING TO FIGURE THIS OUT ON MY OWN. EXAMPLE OF THAT MIGHT BE ASSESSMENT FOR CHILD
MALTREATMENT, RIGHT? SO, AGAIN, IN THE EMERGENCY DEPARTMENT MY
JOB IS TO BE CONCERNED ABOUT ALL THE LIFE AND LIMB THREATENING EMERGENCIES. SOMETIMES THOSE EMERGENCIES ARE THINGS HAPPENING
TO YOU SOCIALLY THAT MAY NOT BE DIRECTLY CAUSED BY THE THINGS HAPPENING IN YOUR BODY, BUT
EXTERNAL FACTORS. SO THERE ISN’T A TEST FOR WHETHER OR NOT A
CHILD HAS BEEN MALTREATED. THAT’S AN ASSESSMENT. WE’LL TALK ABOUT HOW WE FIGURE THAT OUT IN
A MOMENT. A PROTOCOL OFTEN ALSO COMPLETED IS AN ALGORITHMIC
SET OF ACTIONS THAT MOBILIZES A DEDICATED TEAM WHEN AN OUTCOME OF INTEREST OR CONCERN
FOR OUTCOME ARISES. THAT MEANS THAT IT’S JUST A FLOWCHART WE SAW
EARLIER TODAY, RIGHT? IF THIS, THEN THIS. THEN DO THIS. THEN CALL BOB. THEN TALK TO SALLY. THEN DO THIS. RIGHT? THE WAY YOU MIGHT THINK ABOUT A PROTOCOL IS
IN THE EMERGENCY DEPARTMENT EVERYTHING’S IN THE E.D., THAT’S MY LIFE, IN THE E.D. IF WE GET A NOTE CALL FROM EMS THAT SOMEONE
MAY OR MAY NOT BE HAVING A STROKE, I COULD BE IN THE BATHROOM FOR 20 MINUTES, THEY DON’T
NEED ME. THERE’S A PROTOCOL. I’M NOT SPECIAL OR IMPORTANT. IT IS NOT DEPENDENT ON THE USERS, THE ACTIONS
ARE GOING TO HAPPEN. SO THE PHONE RINGS, AND WHOEVER ANSWERS THE
PHONE, THE CHARGE NURSE SITTING CLOSEST, THEY HEAR WE HAVE A STROKE NOTE. ETA 4 MINUTES. THEY TURN TO THE CLERK, CLERK CALLS THE OPERATOR,
I DON’T KNOW HOW IT HAPPENS, IT’S MAGIC. CT IS AWARE, NEUROLOGY IS MADE AWARE. X RAY IS MADE AWARE, EKG TECH, EVERYBODY WHO
MIGHT HAVE TO TOUCH THIS PATIENT IS MADE AWARE BEFORE I’M STILL IN THE BATHROOM. THIS ACTUALLY HAPPENED TO ME MY LAST SHIFT
TWO DAYS AGO. I WAS IN THE BATHROOM. THE NOTE CAME. NOT 20 MINUTES. [LAUGHTER]
BUT I WAS THERE. NOTE CALL CAME. BY THE TIME I CAME OUT OF THE BATHROOM THE
PATIENT WAS ALREADY IN CAT SCAN. FOR STROKE, TIME IS BRAIN. THAT’S PROTOCOL. NOTHING TO DO WITH WHETHER OR NOT I KNOW THAT
PERSON HAS A STROKE, I DON’T KNOW. THIS PROTOCOL GOES INTO PLACE. VALIDATION IS NOT AN EXPERT OPINION. THAT’S IMPORTANT BECAUSE WE DON’T NECESSARILY
KNOW IF WE’RE MEASURING WHAT WE THINK WE’RE MEASURING. AN EXAMPLE OF VALIDATION MIGHT BE IF YOU HAVE
A PULMONARY EMBOLISM OR BLOOD CLOT THERE’S CERTAIN TESTS TO ASSESS WHETHER YOU HAVE THAT
PROBLEM. IF
A NEW TEST, IS IT AS GOOD AS THE OTHER RISKY THING I’M DOING, TEST AGAINST THAT, NOT AGAINST,
OH, THE PERSON WHO INVENTED IT THINKS IT’S GOOD. I BET THEY DO. OF COURSE THEY DO. WHY IS IT IMPORTANT? SCREENING ALLOWS FOR PATIENT DISCLOSURE REGARDLESS
OF USER BIAS. IT MEANS I’M NOT I HAVE THE OPPORTUNITY TO
DISCLOSE BASED ON CERTAINLY HOW I UNDERSTAND THE QUESTION, WHETHER I FEEL THAT YOU’RE A
SAFE PERSON THAT I WANT TO TELL, ET CETERA, BUT ALLOWS THAT OPPORTUNITY. IT ALLOWS FOR DISCLOSURE BUT DOES NOT REQUIRE
IT. SCREENING ONCE DOESN’T MEAN YOU FOUND IT AND
RULED IT IN OR OUT. YOU COULD SCREEN 100 TIMES, A PERSON MAY NOT
BE TRAFFICKED ONE DAY BUT MAY BE TRAFFICKED ANOTHER DAY, THEY WERE OUT BUT THEY ARE NOW
BACK IN. ASSESSMENT, IF I CAN’T DO THE CHILD MALTREATMENT
ASSESSMENT I’M CALLING AN EXPERT WHO IS QUALIFIED TO SORT THIS OUT. A PROTOCOL ENABLES RELIABLE ACTION REGARDLESS
OF USERS. THE STROKE NOTE, THEY DIDN’T NEED ME. ANY DOCTOR COULD HAVE WRITTEN UP THE ORDER,
IT ALREADY HAPPENED. THEY DIDN’T NEED ME. VALIDATION TELLS THE USER THE TEST ACTUALLY
MEASURES WHAT IT PURPORTS TO MEASURE, NOT WHAT WE HOPE IT MEASURES OR THINK IT MEASURES,
BECAUSE IF WE’RE NOT SURE WE MAY BE LEADING OUT A GROUP OF PEOPLE LEAVING OUT A GROUP
OF PEOPLE SYSTEMATICALLY. EXAMPLES OF GAPS IN THE LITERATURE, WE HAVE
THREE MINUTES, GREAT. SO VALIDATION, WE DON’T HAVE A TON OF VALIDATED
TOOLS IN THE HEALTHCARE FIELD. THERE ARE SOME THAT DO EXIST IN THE SOCIAL
SERVICE SETTING. SO IF YOU THINK ABOUT THE INSTITUTE IN 2014,
TRAFFICKING VICTIMS IDENTIFICATION TOOL, THEY CALL IT A SCREENING AND IT MAY WORK BUT IT’S
REALLY ASSESSMENT BECAUSE YOU NEED TO THE USER HAS TO INTERPRET THE DATA. THERE’S NO NUMBER THEY CAN SAY, AH, YOU SCORED
16 OUT OF 32, THIS IS TRAFFICKING. YOU CAN GET A 2 AND IT’S TRAFFICKING. THE USER HAS TO KNOW WHAT TRAFFICKING IS. IT’S VALIDATED BUT NOT IN THE HEALTHCARE SETTING. IT CAN TAKE 45 MINUTES TO ADMINISTER. I’M NOT USING THAT IN THE E.D. AS MY SCREENING TOOL. THERE’S A TOOL I’M GOING TO LEAVE A HOVER
SUSPENSE, GREENBAUM TOOL. YOU’LL HEAR, STANDBY. YOU’LL HEAR MORE. IT’S THE ONLY ONE VALIDATED FOR USE IN THE
EMERGENCY DEPARTMENT, BUT IT’S VERY SPECIFIC WHO IT’S FOR. THIS IS WHEN WE GET TO COMPREHENSIVE TOOLS. GREENBAUM TOOL IS FOR IDENTIFICATION OF CHILD
SEX TRAFFICKING IN A PARTICULAR POPULATION, HIGH RISK CHIEF COMPLAINT THAT PRESENTS A
TO A HEALTH CARE SETTING, 13 TO 17 YEAR OLDS, HOW DOES IT WORK IN A 42 YEAR OLD? I DON’T KNOW. DOES IT WORK IN A 42 YEAR OLD? I DON’T KNOW. WHAT IF THE CHILD IS LABOR TRAFFICKED? WE DON’T HAVE THAT TOOL YET THAT CAN ASSESS
FOR LABORS IN ALL POPULATIONS. YOU CAN’T TALK TO A 6 YEAR OLD THE WAY YOU
TALK TO A 17 YEAR OLD OR 5 2 YEAR OLD. THEY HAVE DIFFERENT PEOPLE. WE NEED A LOT MORE PRECISION IN OUR LANGUAGE
AND WE HAVE TO BUILD THE EVIDENCE BASE THERE. WE NEED VALIDATED SCREENING TOOLS, VALIDATED
ASSESSMENT TOOLS, PROTOCOL TOOLS THAT WORK, THAT REQUIRES MY FAVORITE THING, RESEARCH. I’LL END THERE. I HAVE A FEW SECONDS BUT WE CAN MOVE FORWARD. THANKS SO MUCH FOR YOUR TIME. [APPLAUSE]>>GOOD AFTERNOON. I’M MARY LANDERHOLM, WITH THE LABORATORY TO
COMBAT HUMAN TRAFFICKING. I WANT TO SAY THANK YOU TO THE SYMPOSIUM COMMITTEE
FOR THE INVITE TO THIS SYMPOSIUM, ABSOLUTELY AMAZING. I’D LIKE TO MAKE A SHOUT OUT TO MY COLLEAGUES
FROM THE LABORATORY TO COMBAT HUMAN TRAFFICKING IN DENVER, COLORADO, AND MANY OF MY OTHER
COLLEAGUES FROM AROUND THE COUNTRY THAT ARE HERE WITH US TODAY. AND THIS WAS A GREAT LEAD IN TO THE CONVERSATION
AND COMPLEXITIES AROUND SCREENING AND ASSESSMENT, AND I WAS ASKED TO BE HERE TODAY TO SPEAK
ABOUT A PROJECT THAT I HAD AN OPPORTUNITY TO DO IN RELATIONSHIP WITH NITAAC AND ASHLEY
GARRETT THAT TALKS ABOUT COMPLEXITIES AROUND SCREENING, NUANCES, AND THE HOW DO I PUT THIS
TERM? THE SPACE THAT IS NEEDING TO BE HELD FOR THESE
CONVERSATIONS AROUND SCREENING ASSESSMENT, DIFFERENT POPULATIONS, DIFFERENT EXPERIENCES,
VULNERABILITIES. SO IN 2017, I WAS APPROACHED BY NITAAC AND
ASHLEY GARRETT ON A PROPOSAL TO CONNECT WITH A PUBLIC HEALTH INITIATIVE, A PUBLIC HEALTH
ORGANIZATION IN COLORADO, TO SUPPORT THEM AND COMBATING HUMAN TRAFFICKING. THAT ORGANIZATION COMMUNITY REACH CENTER IN
COLORADO IS AN ORGANIZATION OVER 600 EMPLOYEES WITH 14 SITES WORKING WITH DOMESTIC AND FOREIGN
NATIONAL INDIVIDUALS, SCANNING FOR MENTAL HEALTH, BEHAVIORAL HEALTH, PHYSICAL HEALTH
SERVICES AND HAD 29 DIFFERENT PROGRAMS IN THEIR ORGANIZATION. NITAAC PAIRED MYSELF AND CRC TOGETHER TO START
TO LOOK AT THE WAYS TO SUPPORT CRC AND BETTER UNDERSTANDING THIS ISSUE AND HOW THEY SUPPORTED
THOSE THAT THEY SERVED. SO FROM THAT PROCESS, WE WERE ABLE TO DO AN
ORGANIZATIONAL AUDIT, WHICH ALLOWED ME AND CRC TO UNDERSTAND THE BARE BONES AND WHAT
CRC HAD COMING TO THE TABLE AROUND EXPLOITATION AND HUMAN TRAFFICKING. THROUGH THAT ORGANIZATIONAL ASSESSMENT, SCREENING
AND ASSESSMENT WAS A CONVERSATION. WE LOOKED AT TRAINING AND EDUCATION, CAPACITY
BUILDING AND CRC’S OWN REPRESENTATION IN THE COMMUNITY IN OUR STATE OF COLORADO. SO WHEN I DELVE A LITTLE DEEPER INTO CRC’S
SCREENING, OR ASSESSMENT, AT THAT TIME IN 2017 THERE WERE QUITE A FEW BARRIERS OR GAPS,
IF YOU WILL, THAT WAS HAPPENING AROUND SCREENING. MORE PARTICULAR, I WAS LOOKING AT THE SCREENING
PROCESS AS A WHOLE, AND LOOKING AT THE ENVIRONMENT OF WHERE A SCREENING TOOL WOULD BE OR IF THERE
WAS ONE IN PLACE, SO WE LOOKED AT WHERE QUESTIONS WERE BEING ASKED WITHIN THE PROCESS AT CRC,
ALSO LOOKING AT THEY LOOKING AT HOLISTICALLY AT RISK, EXPLOITATION, QUESTIONS EMBEDDED
IN THE LARGE ORGANIZATION, 600 EMPLOYEES, 29 PROGRAMS THIS ORGANIZATION OFFERED. THE POPULATION THEY SERVED WAS FROM CRADLE
TO GRAVE SO YOU CAN IMAGINE AN ASSESSMENT TOOL OR SCREENING TOOL FOR 2 YEAR OLD VERSUS
SOMEONE WHO IS 70, THAT’S A VERY DIFFERENT EXPERIENCE AND VERY DIFFERENT CONVERSATION. PROGRAMS RANGED FROM SCHOOL BASED NURSES AND
CLINICS TO JAIL SERVICES, SO THIS WAS A MASSIVE AMOUNT OF CONTACTS AND NUANCES WE NEEDED TO
UNDERSTAND FOR CRC BEFORE WE EVER BEGAN TO HAVE A CONVERSATION AROUND SCREENING OR ASSESS. IN THAT PROCESS ALSO WE WANTED TO KNOW THE
QUESTIONS THAT WERE BEING ASKED CURRENTLY WITHIN CRC’S FRAMEWORK, THE PLACEMENTS OF
QUESTIONS WITHIN THAT INTAKE PROCESS, WHO WAS SCREENING, WHEN, HOW OFTEN, WAS IT A ONE
STOP SHOP, WERE THEY BEING REPEATED. DISCLOSURES HAPPEN ALL OVER THE PLACE. WE LOOKED AT CONSIDERATION FOR CONSUMERS,
A WIDE VARIETY OF CONSUMERS, DEMOGRAPHIC, CULTURAL COMPETENCIES THAT NEED TO BE TAKEN
INTO CONSIDERATION. WE LOOKED AT INTERPRETATION AND LANGUAGE BARRIERS
THAT WERE HAPPENING, AND WHAT WAS ALREADY AT PLACE WITHIN THOSE SPACES. AND THEN WE ALSO LOOKED AT STAFF TRAINING
AND TRAINING ROLES WITHIN THESE DIFFERENT 29 PROGRAMS. I’LL NOTE HERE THAT THERE WAS NO TIME CAPACITY
TO BE ABLE TO ONBOARD 29 PROGRAMS SO WHAT WE DID IS I SAT DOWN AND LOOKED AT ALL THE
PROGRAMS AND IDENTIFIED THEM INTO THREE CATEGORIES, WHERE INDIVIDUALS WHO EXPERIENCED EXPLOITATION
WERE LIKELY TO CONNECT WITH SERVICES, WHERE WAS MEDIUM RANGE, AND WHERE THEIR SERVICES
MAY HAVE BEEN AT THE LONGER RANGE. WHAT THAT LOOKS LIKE IS THEY HAD HOSPICE CARE
TO JAIL SERVICES SO WE LOOKED AT THE SPACES WHERE I THOUGHT THAT A SURVIVOR MAY ENGAGE
WITH THOSE 29 DIFFERENT PROGRAMS AND ASSESSED AND MADE A TIER OUT PROGRAM APPROACH. WHEN WE LOOKED AT STARTING TO TALK ABOUT SCREENING,
IT CAME PRETTY APPARENT THAT THIS ORGANIZATION WAS NOT ABLE TO ENGAGE IN SCREENING AND ASSESSMENT
CONVERSATIONS BECAUSE THEY HAD NOT BEEN TRAINED. IT WAS SUPER DIFFICULT FOR ME TO HAVE ANY
OF THIS MOMENTUM ON THAT, IF WE DIDN’T HAVE A CONCRETE FOUNDATION OF WHAT THIS ISSUE LOOKED
LIKE. NOT ONLY BROADLY BUT IN CONTEXT WITHIN THE
COLORADO CONTACTS. I HIGHLY RECOMMEND ANYBODY WHO IS LOOKING
AT SCREENING AND ASSESSMENT TO BE GROUNDED IN THE ANTI TRAFFICKING MOVEMENT WITHIN YOUR
STATE, AND WITHIN YOUR LOCAL JURISDICTIONS OR WHERE YOU LIVE. THEY LOOK VERY DIFFERENT ACROSS COLORADO. WE’RE A DIVERSE STATE WHERE WE HAVE VERY SATURATED
SPACES AROUND DENVER BUT HAVE POCKETS AND STILL DO HAVE POCKETS OF RURAL AREAS WHERE
MANY FOLKS WHO ARE ENTERING CRC SPACES WERE NOT GETTING THE ADEQUATE TRAINING AS STAFF
TO UNDERSTAND WHAT THIS LOOKED LIKE. SO WHAT NITAAC AND I DID WAS WE REACHED OUT,
I’M STAFF AT THE LABORATORY TO COMBAT HUMAN TRAFFIC AS A SOCIAL WORKER, HAD INSIDE INFORMATION
GOING ON THERE. WAS ABLE TO ONBOARD CRC INTO TRAINING ONE
WITH NITAAC SOAR TRAINING AND LABORATORY TO COMBAT HUMAN TRAINING IN COMPREHENSIVE 4P
FRAMEWORK I’LL SHOW IN A SECOND. WE REALLY CAME IN FIRST AND DID THIS TRAINING
WITH CRC TO UNDERSTAND WHAT THE CRIME LOOKED LIKE LOCALLY, ALSO BROUGHT IN SOAR TRAINING
TO HELP WITH HEALTH CARE AND PUBLIC HEALTH APPROACH, TO BEGIN TO HAVE A RICHER DIALOGUE
AROUND WHAT SCREENING AND ASSESSMENT COULD POSSIBLY LOOK LIKE FOR THEM. IN THE CONTEXT OF COLORADO RESEARCH BASED
INITIATIVE BROUGHT IN THE COLORADO PROJECT WHICH LOOKED AT THE WAYS THE STATE OF COLORADO
HAD IN THE PAST RESPONDED TO THE CRIME, NOT ONLY WHO WAS DOING WHAT BUT ALSO HOW. THIS GAVE CRC A GOOD FRAMEWORK WHAT THE COLORADO
ANTI TRAFFICKING MOVEMENT LOOKED LIKE IN 2013, AND ALSO WHAT WAS AHEAD IN OUR 2018 RESEARCH
PROJECT THAT WE’VE BEEN WORKING ON THIS SUMMER. ALSO HELPING THEM UNDERSTAND THE 4P FRAMEWORK
KEEPING CRC AND ORGANIZATIONS AND ANYBODY IN THIS WORK OUT OF THAT SINGLE SILO FOCUS
OF JUST A RESCUE RESTORE MODEL, UNDERSTANDING MANY OF THESE COMPONENTS NEED TO BE AT THE
TABLE, TO THINK ABOUT ASSESSMENT AND SCREENING AND MOVING FORWARD. WE GAVE CRC THE ACTION PLAN, COLORADO ACTION
PLAN DRIVEN FROM THE COLORADO PROJECT THAT SHOWED GAPS AND STRENGTHS UNDER 14 RECOMMENDATIONS,
48 ACTIVITIES CRC EMBEDDED IN THE ORGANIZATION AND RESPONSE TO TRAFFICKING. WE DID NOT HAVE A GOOD SCREENING SPACE WE
NEEDED TO PUT IN SOME FORM OF GAP STOP TO HELP SUPPORT THEM FOR ANYONE WHO IS UNIDENTIFIED
IN THE CURRENT MOMENT, WHILE THEY WERE TRYING TO FIGURE OUT PROTOCOLS AND PROCEDURES INTERNALLY. WE HOOKED THEM UP WITH COLORADO NETWORK TO
END HUMAN TRAFFICKING HOTLINE, WHICH WE HAVE A VETTED RESOURCE DIRECTORY OF 300 PARTICIPANTS
WHO CAN PROVIDE SERVICES FOR FOLKS WITH LIVED EXPERIENCES, SO THEY BEGAN TO CONNECT WITH
THE DIRECTORY AND CONNECT WITH THE FOLKS WITHIN OUR STATE TO CONTINUE TO MOVE FORWARD. AFTER TRAINING, ONBOARDING INTO THE LOCAL
RESEARCH THAT WE HAD EMBEDDED IN OUR STATE, UNDERSTANDING THE 4P FRAMEWORK AND HOTLINE,
WE WERE ABLE TO START TO TALK ABOUT MOVING FORWARD FOR CRC, ITS RELATIONSHIP WITH NITAAC
AND AND LABORATORY TO COMBAT HUMAN TRAFFICKING. FORWARD CONSIDERATIONS TO LOOK AT SPECIFIC
PROGRAMS WITHIN CRC AND HOW ASSESSMENTS MAY LOOK DIFFERENTLY FOR JAIL SERVICES VERSUS
SCHOOL BASE AND SOCIAL WORKERS. WE LOOKED AT STAFF RESPONSE, AGAIN LONG TERM
SURVIVORSHIP, THAT WILL LOOK DIFFERENT FOR MANY DIFFERENT PEOPLE AND HAVING CRC UNDERSTAND
WHAT THAT TOUCH POINT MIGHT BE DOWN THE ROAD. WE ALSO BEGAN TO HAVE CONVERSATIONS WITH THEM
ABOUT COMMITTING TO SYSTEMWIDE CONVERSATIONS AROUND SCREENING, AGAIN 600 EMPLOYEES, 29
DIFFERENT PROGRAMS, THIS WAS JUST THE BEGINNING OF A CONVERSATION FOR THEM. THROUGH THIS PARTNERSHIP WE WERE ABLE TO GET
CRC EMBEDDED IN THE LOCAL CONTEXT, ABLE TO CONNECT WITH COLORADO DEPARTMENT OF HUMAN
SERVICES, ONBOARD CHILD WELFARE MANDATES SINCE 2016, UNDERSTAND KEY POINTS IN THE RESPONSE
IN THE COLORADO, BEGINNING TO PLUG THEM INTO CAPACITY BUILDING. I HAVE ONE MORE MINUTE. I WANT TO OFF TOPIC, I WANT TO HOLD SPACE
HERE FOR A SECONDS AROUND LONG TERM SURVIVORSHIP AND WHAT THAT’S MEANT FOR ME. I’VE BEEN ASKED WHAT DOES JUSTICE MEAN FOR
YOU, MARY, I WANT TO SHARE HEALTH CARE HAS BEEN PART OF MY JUSTICE. MY JUSTICE FOR MY EXPERIENCE WAS NOT LOCKING
UP MY TRAFFICKER, THE MOMENT I GOT JUSTICE WAS WHEN I FOUND A TRAUMA INFORMED PHYSICIAN
AND WAS ABLE TO BEGIN TO HAVE LONG TERM REPEATED PREVENTIVE HEALTH CARE WITHIN MY EXPERIENCE. AND SO OFTENTIMES WE THINK ABOUT JUSTICE AND
VERY DIFFERENT FORMS, BUT MANY OF US WHO EXPERIENCED EXPLOITATION WILL HEALTH YOU HEALTH CARE ACCESS
HAS BEEN A BARRIER. I’M ONE OF THOSE PEOPLE WHO ACCESSED HEALTH
CARE OFTEN IN MY EXPERIENCE AND WAS NOT IDENTIFIED, SO HAVING THE ABILITY TO HAVE PHYSICIANS AND
HEALTH CARE BE PART OF MY LONG TERM RECOVERY HAS ABSOLUTELY CHANGED MY LIFE. THANK YOU. [APPLAUSE]>>HI, GOOD AFTERNOON. THANK YOU FOR INVITING ME AND HAVING ME, OTIP,
AND NITAAC, I’M EXCITED TO BE HERE. I’M ANNA MARJAVI, I WORK WITH NATIONAL HEALTH
RESOURCE CENTER ON DOMESTIC VIOLENCE, A PROJECT OF FUTURES WITHOUT VIOLENCE, NATIONAL NON
PROFIT, AND AS PART OF OUR ROLE WITH THE HEALTH RESOURCE CENTER WE HAVE BEEN INNOVATING AND
THINKING ABOUT RESPONSES TO DOMESTIC VIOLENCE AND HEALTHCARE SETTINGS FOR OVER 25 YEARS,
AND IN THE PAST YEAR AND A HALF, WE’VE BEEN PILOTING SOME INTEGRATED RESPONSES TO BOTH
INTIMATE PARTNER VIOLENCE AND TRAFFICKING IN COLLABORATION WITH ACS, SIPSA OFFICE, KENYA
FAIRLEY AND DR. MATOFF STEPP, AND TRACY BRANCH SO WE’RE SO
FORTUNATE TO HAVE LEADERSHIP LIKE THAT AT THE FEDERAL LEVEL. SO IN DOING THIS WORK, WHATEVER HEALTH CARE
SYSTEM IS UNDERTAKING THIS WORK, WE REALLY BELIEVE STRONGLY IN THE PARTNERSHIP ASPECT
OF IDENTIFYING AND CONNECTING WITH LOCAL COMMUNITY BASED PROGRAMS LIKE DOMESTIC VIOLENCE PROGRAMS,
HUMAN TRAFFICKING PROGRAMS, AND REALLY SEEING THEM AS KEY PARTNERS, AS SOON AS YOU JUST
BEGIN TO THINK ABOUT UNDERTAKING SYSTEM CHANGE OR TALKING TO YOUR PROVIDERS OR PATIENTS ABOUT
THIS TOPIC. WE REALLY PROMOTE THE IDEA OF MAKING BIDIRECTIONAL
REFERRALS. WE SEE STRENGTHS ON BOTH SIDES. SO ON THE COMMUNITY HEALTH CENTER SIDE WITH
FQHCs, THEY SEE THIS ISSUE IN THE PATIENT POPULATION BUT DON’T ALWAYS KNOW HOW TO HAVE
CONVERSATIONS. WE HAVE AN INTERVENTION THAT I’M GOING TO
TALK ABOUT THAT FOCUSES ON UNIVERSAL EDUCATION AND MOVES AWAY FROM SCREENING A LITTLE BIT
AND FOCUSES ON THIS BROCHURE SOME OF YOU HAVE, THERE’S MORE ON THE TABLE OUT THERE. ON THE DOMESTIC VIOLENCE SIDE, ON TRAFFICKING,
TO WHAT MARY SAID, A LOT OF SURVIVORS GOING TO PROGRAMS HAD RESTRICTIONS IN TERMS OF ACCESS
TO HEALTH CARE BECAUSE OF THE CONTROL THEY HAVE EXPERIENCED, OR BECAUSE IT HASN’T BEEN
A PRIORITY. THEY HAVE HAD TO MINIMIZE TO DEAL WITH OTHER
THINGS GOING ON. A LOT OF PEOPLE HAVE ACUTE HEALTH CARE NEEDS,
MAY NOT HAVE A MEDICAL HOME, HAVE NOT SEEN A PROVIDER IN SOME TIME. ADVOCATES ARE KEY IN OPENING UP THAT CONNECTION
AND REFERRAL OVER TO COMMUNITY HEALTH CENTERS TO HELP GET THEM ENROLLED, TO HELP THEM GET
SEEN IN A TIMELY WAY, ESPECIALLY THINKING ABOUT STRANGULATION, STI AND SPO HEALTH NEEDS
TO GET SEEN IN AN EXPEDITED WAY, HAVING THE GOLDEN TICKET, HOW THE CLIENTS ARE REFERRED
TO ONE ANOTHER. WE’VE SHIFTED THE WAY WE MEASURE SUCCESS. SUCCESS IS NOT MEASURED THIS IS ACTUALLY A
CHALLENGE FOR SOME HEALTH CARE PROVIDERS, USED TO FIXING PEOPLE’S PROBLEMS OR TELLING
PEOPLE IN A DIRECTIVE WAY WHAT TO DO. THAT WE CHALLENGE THAT. WE SAY SUCCESS IS MEASURED BY OUR EFFORTS
TO REDUCE ISOLATION WHICH SO MANY SURVIVORS FACE, AND TO IMPROVE OPTIONS FOR SAFETY AND
HEALTH AND HEALING. REFLECTING ON THINGS THROUGH IPV SCREENING,
DESPITE PEOPLE’S BEST INTENTIONS SOMETIMES WHEN IT’S ACTUALLY PUT INTO PRACTICE IT DOESN’T
ALWAYS COME OUT THE BEST WAY. I THINK PROBABLY MANY OF US IN THE AUDIENCE
HAVE HAD THAT EXPERIENCE WITH OUR OWN PROVIDERS WHETHER GOOD OR BAD. A FEW EXAMPLES, NO ONE IS HURTING YOU AT HOME,
RIGHT? IT’S A PARTNER SEATED NEXT TO A CLIENT AS
THIS IS ASKED. YOU CAN IMAGINE ASKING THESE KINDS OF QUESTIONS,
PEOPLE ARE ACCOMPANIED BY PARTNERS OR FRIENDS CAN BE VERY DANGEROUS AND IS NOT ALWAYS A
GREAT CLIMATE TO HAVE A REAL CONVERSATION. SOMETHING ELSE, THE NURSE IS BACK HERE, TYPING
ON THE COMPUTER WITH HER BACK TO YOU, IN THE LAST YEAR HAS HE HIT OR HURT YOU, SOMETIMES
UNINTENTIONALLY CLOSING OURSELVES OFF, NOT BEING RECEPTIVE OR OPEN TO WHAT OUR PATIENT
MAY WANT TO TELL US. AND ANOTHER ONE IS I’M REALLY SORRY, I HAVE
TO ASK YOU THESE QUESTIONS, IT’S A REQUIREMENT OF OUR CLINIC, WITH THE SCREENING TOOL IN
THEIR HAND. SO SOMETIMES THEY MIGHT BE GOOD INTENTIONS
BUT THEY ARE TAKING CARE OF THEMSELVES. THEY HAVE A LOT OF THEIR OWN EXPERIENCE WITH
TRAUMA AND ABUSE. THINKING ABOUT SYSTEM CHANGE WE BEGIN, HOW
CAN WE SUPPORT STAFF, THEIR HEALING, WHAT THEY HAVE GONE THROUGH TO INCREASE NOT ONLY
THEIR HEALING BUT THEIR CAPACITY TO TALK THEIR PATIENTS ABOUT THIS. STARTING THERE IN TERMS OF TRAUMA INFORMED
SUPPORT FOR EMPLOYEES. SO WHAT IF WE CHALLENGE THE LIMITS OF DISCLOSURE
DRIVEN SCREENING PRACTICES WHERE YOU’RE ASKING A REALLY POINTED DIRECTED QUESTION AND LOOKING
FOR A YES OR NO ANSWER? IT IS A LITTLE BIT OF A POWER SHIFT THAT WE
THINK ABOUT A LITTLE BIT BECAUSE SO OFTEN HEALTH CARE PROVIDERS HAVE SO MUCH INFORMATION
AT THEIR DISPOSAL IN THEIR HEADS AND FINGER TIPS, AND SOMETIMES WHEN ASK YOU A POINTED
QUESTION AND IF YOU DON’T GET THAT YES YOU’RE LOOKING FOR, THAT PATIENT MIGHT NOT GET ANY
INFORMATION OR RESOURCES WHATSOEVER. WHEN YOU LOOK AT PREVALENCE RATES, YOU LOOK
AT SCREENING RATES, THERE’S A BIG DISPARITY, RIGHT, IF YOU ACTUALLY LOOK AT THE NUMBER
OF PEOPLE THAT ARE DISCLOSING COMPARED TO NUMBER OF PEOPLE WE KNOW EXPERIENCE ABUSE
AND TRAUMA. SO WE KNOW THERE’S A LOT OF GOOD REASONS WHY
PEOPLE JUST DON’T FEEL COMFORTABLE DISCLOSING. AND A LOT OF CONCERN ABOUT BEING PUT IN DATA
BASES, WHAT HAPPENS TO YOUR INFORMATION, CONCERN ABOUT CHILDREN AND REPORTING. A LOT OF PEOPLE THAT COME BEFORE US IN HEALTH
CARE PRACTICES ARE GOING THROUGH THESE THINGS BUT MAYBE AT THAT TIME IT’S NOT SAFE OR THEY
DON’T FEEL COMFORTABLE SPECIFICALLY TALKING ABOUT WHAT’S GOING ON. HOWEVER, HEALTH CARE PROVIDERS CAN STILL IMPART
INFORMATION AND RESOURCES REGARDLESS OF WHAT THEY SAY. PROVIDING AN OPPORTUNITY FOR CLIENTS TO MAKE
THE CONNECTION BETWEEN VIOLENCE, ABUSE, HEALTH PROBLEMS AND RISK BEHAVIORS, COUPLED WITH
SCREENING, IT CAN COME BEFORE SCREENING. SO WHEN WE LOOK AT WHAT SURVIVORS HAVE SAID
IN TERMS OF WHAT HUMAN TRAFFICKING SURVIVORS, LABOR AND SEX TRAFFICKING SURVIVORS HAVE SAID,
THEY WANT HEALTH CARE PROVIDERS TO INFORM THE PATIENT OF THEIR RIGHT TO SPEAK ALONE
WITH THE DOCTOR, TO PROVIDE GENUINE CARE SO THE TRAFFICKED INDIVIDUAL KNOWS THEY ARE WORTH
BEING CARED FOR, TO INFORM THE PATIENT OF RESOURCES THAT ASSIST TRAFFICKED INDIVIDUALS
AND HELP THEM GET OUT OF THEIR SITUATIONS, AND TO LOOK FOR FLAGS IF A PATIENT CAN’T ANSWER
QUESTIONS ABOUT THEIR PHYSICAL BEING, AND/OR HISTORY OF PRIOR PROCEDURES INCLUDING AGGRESSIVE
BEHAVIOR, TERRIFIED BEHAVIOR, NOT WANTING THE HEALTH CARE PROVIDER TO TOUCH THE PATIENT. THESE ARE RECOMMENDATIONS FROM SURVIVORS. SO AS PART OF OUR INTERVENTION, WE CHALLENGE
HEALTH SYSTEMS FIRST TO ALWAYS SEE PATIENTS ALONE, TO MAKE THAT A POLICY IN THEIR CLINIC,
A BIG CULTURAL SHIFT FOR THEIR PATIENTS, BUT AS CAN BE AS SIMPLE AS PUTTING A SIGN UP,
ENSURING YOU’RE ALWAYS SEEING PATIENTS ALONE FOR AT LEAST PART OF THE VISIT, NOT DOING
THE PROBLEM SOLVING OR TIP TOWING TRYING TO SEPARATE PEOPLE, IT’S MORE DANGEROUS FOR STAFF
AND DIFFICULT. OUR EVIDENCE BASED INTERVENTION, MONIKER IS
CUES, CONFIDENTIALITY, UNIVERSITY EDUCATION, DONE THROUGH A BROCHURE LIKE THIS, WE HAVE
THEM FOR DIFFERENT SETTINGS AND POPULATIONS, MULTI LINGUAL. EMPOWERMENT PIECE, WE GIVE TWO, NOT ONE, TO
EVERY PATIENT. AND WITH SOMETHING I’VE STARTED GIVING TWO
OF THESE CARDS TO ALL OF MY PATIENTS, IN CASE IT’S AN ISSUE FOR YOU BECAUSE RELATIONSHIPS
CAN CHANGE. ALSO SO YOU HAVE THE INFO TO HELP A FRIEND
OR FAMILY MEMBER IF IT’S AN ISSUE FOR THEM. THAT’S THE EMPOWERMENT PIECE. PEOPLE LIKE FEELING LIKE THEY CAN BE HELPERS. ALTRUISM IS IMPORTANT, ESPECIALLY WITH ADOLESCENTS,
WHO ASK FOR EXTRA OF THESE CARDS FOR THEIR FRIENDS AND FAMILY. AND AS YOU OPEN THIS, I DON’T HAVE TIME TO
GO THROUGH IT BUT IT’S LOW LITERACY, INTEGRATES IPV AND HUMAN TRAFFICKING DYNAMICS, DOESN’T
NAME THOSE THINGS BECAUSE A LOT OF TERMS WE USE ARE NOT RELATABLE, YOU’LL SEE MORE DYNAMICS
HERE. THE SUPPORT IS YOU CAN ALWAYS OFFER REFERRAL
TO A PATIENT WHETHER THEY DISCLOSE OR NOT TO LET THEM KNOW WHAT’S AVAILABLE IN THE COMMUNITY,
WHAT AN ADVOCATE DOES, HOW TO REACH THEM, A LITTLE BIT ABOUT THOSE RESOURCES. THIS IS OUR ADOLESCENT CARD, WE HAVE THEM
FOR ADULTS ACROSS THE LIFESPAN, I MENTIONED MULTI LINGUAL, ACROSS CULTURAL. AND IN ADDITION WHEN SOMEONE DOES DISCLOSE
WE ALSO WORK WITH HEALTH CARE PROVIDERS TO PROMOTE HARM REDUCTION, AND SO KNOWING SOMETIMES
PEOPLE AREN’T GOING TO CHANGE THEIR SITUATIONS RIGHT THEN AND THERE, THEY ARE GOING BACK
INTO THEM, HOW CAN YOU RECOGNIZE HOW CAN YOU STILL SUPPORT THEM TO BE SAFEST WHERE THEY
ARE, AND THEN THINK ABOUT THAT SHORT AND LONG TERM SAFETY PLANNING. SO DISCLOSURE WE’VE HEARD A LOT THIS MORNING,
NOT THE GOAL. AND DISCLOSURES DO HAPPEN. SO SIMPLE ONE LINE SCRIPTS CAN BE REALLY PROFOUND
WHEN SOMEONE FELT ISOLATE AND THEY HAVE BEEN PUT DOWN AND CONTROLLED. AND THEN OFFERING THAT WARM REFERRAL, HAVING
THE CONNECTION TO YOUR LOCAL ADVOCACY PROGRAM, KNOWING THE NAME, HAVING VISITED THEM, KNOWING
WHAT THEY OFFER, WHAT THEIR HOTLINE IS, SO THAT YOU CAN OFFER THAT TO YOUR PATIENT AND
EVEN OFFER YOUR PHONE TO THEM IN THE EXAM ROOM, IT MIGHT BE SAFER FOR THEM TO USE YOUR
PHONE THAN THEIR OWN PHONE. AND REALLY SEEING ADVOCATES AS YOUR KEY PARTNERS
IN DOING THIS WORK. THANK YOU. [APPLAUSE]>>I FELT LIKE A BOBBLEHEAD ALL MORNING THIS
PANEL ESPECIALLY, NODDING ALONG. I’LL DIVE INTO RUNAWAY AND HOMELESS YOUTH. BEAR WITH ME IF THIS DOESN’T FEEL PERTINENT
TO WHAT YOU’RE DOING, BUT MAYBE IT DOES. I AM IN ROCHESTER NEW YORK, CENTER FOR YOUTH
SERVICES, TO GIVE AN IDEA OF THE SIZE OF OUR SIZE WE’RE 200,000 PEOPLE, IS A SMALL CITY. WE HAVE THE JOY AND PLEASURE AND HONOR OF
BEING THE THIRD POOREST FOR THE SIZE OF OUR CITY IN THE COUNTRY. GO, ROCHESTER. AND I RUN A HOST OF SERVICES FOR RUNAWAY AND
HOMELESS YOUTH INCLUDING SHELTER, TRANSITIONAL LIVING, PERMANENT HOUSING, MATERNITY GROUP
HOMES, STREET OUTREACH, CRISIS NURSERY, WHICH IF FOLKS WANT TO TALK TO ME LATER ABOUT WHAT
THAT IS, WE OFTEN WORK WITH FAMILIES WHO ARE IN AN EMERGENCY ROOM WHO HAVE THEIR OTHER
CHILDREN WITH THEM BUT NEED TO BE SEEN OR HAVE ANOTHER CHILD SEEN, WE WATCH THE CHILD
FOR AN HOUR OR SO. WORK WITH FAMILIES IN DOMESTIC VIOLENCE SHELTERS
OR IF A PARENT CALLS AT TWO IN THE MORNING, YOU CAN HEAR THE BABY SCREAMING IN THE BACKGROUND,
I NEED A BREAK, AND THE SERVICE IS NO BARRIER, YOU I DON’T HAVE TO BE REFERRED OR MEET INCOME
ELIGIBILITY, IT’S PURELY BASED ON THE NEED OF THE FAMILY REACHING OUT FOR THOSE SERVICES. I SHOULD PROBABLY SAY BEFORE YOU COME AND
TALK TO ME THERE IS NO FUNDING SOURCE THIS THIS. NOT SOME SECRET FUNDING FROM THE FEDERAL GOVERNMENT. IT’S PURELY RAISED ON LOCAL DOLLARS BUT WE
OPENED A SECOND ONE IN OUR COMMUNITY BECAUSE FOLKS FOUND IT TO BE IMPORTANT, RESONATED
WITH CHILD CARE, MENTAL HEALTH APPOINTMENTS WE HELP WITH. SAFE HARBOR IS SPECIFICALLY OUR PROGRAM THAT
SERVES TRAFFICKED YOUTH OR YOUTH AT RISK FOR TRAFFICKING. IN NEW YORK STATE, IT’S A PROGRAM THAT WORKS
WITH MINORS, SEX AND LABOR. MINERAL COUNTY, IT CAME INTO A RUNAWAY AND
YOUTH HOMELESS PROGRAM, OTHER COUNTIES IMPLEMENTED IN FOSTER CARE, CHILD WELFARE OR CACs, CHILD
ADVOCACY CENTERS, WITH LEGAL FOLKS IN BUFFALO. WE WERE BASED IN RUNAWAY AND HOMELESS YOUTH
WHICH MAKES SENSE WHEN WE TALK ABOUT HOW MANY WE SERVE. I MENTIONED OUR CITY IS 200,000, I HAD OVER
200 YOUNG PEOPLE 12 18 COME THROUGH THE EMERGENCY SHELTER. THAT’S AN INTERESTING NUMBER. AND THEN ANOTHER 50 CAME THROUGH THE TRANSITIONAL
LIVING PROGRAM LAST YEAR. WE GET ALL THE REFERRALS IN THE COUNTY AROUND
TRAFFICKING SO CHILD WELFARE THAT HAS TO ASSESS. I’M SORRY, I’LL PROBABLY USE DEFINITIONS WRONG,
I WANT TO GIVE A SHOUT OUT. WE GET THOSE REFERRALS AND HAD OVER 270 REFERRALS
THAT SAME YEAR FOR TRAFFICKING, AT RISK OF TRAFFICKING. THROUGH THOSE, THE ONES THAT WE DID A FURTHER
CONVERSATION WITH, WE HAD 70 DISCLOSURES IN A VERY SMALL CITY. SO WHAT ARE LESSONS LEARNED? WE’VE HEARD FOLKS TALK ABOUT THIS. ONE THING I HAD TO REALLY WORK WITH MY STAFF
WHEN WE STARTED TRAINING OUR PROGRAMS TO LOOK OUT FOR THIS, WE’RE NOT INVESTIGATORS, THAT’S
NOT OUR JOB TO GET DETAILS. PEOPLE ARE CURIOUS, PEOPLE ARE COMPASSIONATE. THEY WANT TO HELP YOUNG PEOPLE. STAFF GET WRAPPED UP, DID IT REALLY HAPPEN,
REALLY A BLUE CAR, WE HAD TO WORK WITH THEM TO BACK OFF BECAUSE THAT INFORMATION CAN ONLY
BE USED AGAINST THAT YOUNG PERSON LATER BECAUSE IF IT CONTRADICTING ANYTHING THEY SAY TO THE
POLICE OR IF THEY GET INTO A TRIAL, WHICH DOESN’T HAPPEN OFTEN BUT THE DEFENSE ATTORNEY
CAN ASK FOR THE FIGHTS AND REVIEW THEM, IF IT CONTRADICTS IT CAN HURT THEM. ALSO BE CONNECTED TO THE PEOPLE WHO DO IT,
WITH THE CAC, BUILDING RELATIONSHIP WAS LOCAL LAW ENFORCEMENT, HARD, WE OFTEN RESEMBLE THE
POPULATION WE SERVE, RIGHT? WE’RE A BUNCH OF CRANKY SOCIAL WORKERS, OLD
HIPPIES, WHATEVER, PUNK ROCKERS WHO ARE TOTALLY ANTI AUTHORITY, BUT IT REALLY BECAME CLEAR
IT WAS US TO HAVE THAT RELATIONSHIP WITH LAW ENFORCEMENT AND NOT THE YOUTH. I’LL TALK MORE ABOUT THAT LATER. WE ALSO FOUND IT REALLY IMPORTANT TO MAKE
SURE WE HAD SPACE TO IDENTIFY STRENGTHS AND MAKE SURE YOUNG PEOPLE WERE ABLE TO THROUGH
THESE CONVERSATIONS WITH US TALK ABOUT WHAT THEIR GOOD AT AND HOW THEY TOOK CARE OF THEMSELVES
AND SURVIVED, HOW THEY HELPED THEIR FRIENDS SURVIVE, HOW THEY ARE STILL SURVIVING, AND
SOMETIMES IT’S KIND OF HOW THE CONVERSATION EVEN STARTS, WE COME IN SIDEWAYS, WHAT ARE
THEY SEEING WITH FRIENDS, WHAT ARE THEY DOING, HOW DO THEY DO WHEN THEY RAN FROM FOSTER CARE
AND WERE MISSING FOR A MONTH AND RESURFACED, HOW DID YOU TAKE CARE OF YOURSELF, WE’RE GLAD
YOU’RE OKAY. LANGUAGE IS IMPORTANT. PEOPLE HAVE TALKED ABOUT THAT. WE THINK WE KNOW THE LATEST TERMS FOR EVERYTHING. I AM ALMOST 50, I KNOW, DON’T BE SHOCKED,
BUT I DON’T KNOW THE LATEST TERMS. I GOT LOST WITH SNAPCHAT, IT LOST ME COMPLETELY. THINKING WE THINK WE KNOW WHAT YOUNG PEOPLE
ARE SAYING, THAT WE’RE HAVING A SIMILAR CONVERSATION CAN GO REALLY WRONG, REALLY BADLY. I KNOW A TERM THAT GETS USED A LOT IS WORK,
WHAT IS WORK, DID YOU WORK FOR THOSE, DID YOU GET PAID FOR THAT. THAT MIGHT NOT BE THE LANGUAGE THE YOUNG PERSON
IS USING, THEY MAY NOT UNDERSTAND WHAT YOU MEAN BY WORK, A DATE, WHAT YOU MEAN BY EVEN
BEING IN A RELATIONSHIP, RIGHT? SO TAKING THAT TIME TO BUILD A RELATIONSHIP
IS IMPORTANT IN ORDER TO MAKE SURE YOU CAN HAVE THE SAME DEFINITIONS. WHO IS ASSESSING, RIGHT? SO, WE WERE PART OF A LOT OF DIFFERENT TOOLS
AND KIND OF RESEARCH PROJECTS TO TEST TOOLS, DO THE VALIDATIONS, ALL THAT FUN STUFF. AND ONE OF THE THINGS THAT BECAME CLEAR THROUGH
ALL OF THEM IS THAT THE PERSON ASKING THE QUESTIONS WAS JUST AS IMPORTANT AS WHAT THE
QUESTIONS WERE, AND WHETHER THEY WERE DELIVERED AND TO WHOM THEY WERE DELIVERED. FOR EXAMPLE, WE FOUND A PRETTY SIGNIFICANT
CORRELATION BETWEEN THE PERSON ASKING THE QUESTIONS, COMFORT TALKING ABOUT SEX WITH
YOUNG PEOPLE, IF THEY ARE NOT COMFORTABLE TALKING ABOUT SEX WITH TEENAGERS, IF THAT
SQUIRMS THEM, THE YOUNG PERSON IS READING THEIR BODY LANGUAGE AND CAN TELL, EVEN IF
THEY ARE SAYING THE RIGHT WORDS. THEY ARE NOT GOING TO TALK ABOUT THIS WITH
SOMEONE. THE OTHER MAJOR THING WE FOUND WAS THAT INCREDIBLE
BIAS OR DISBELIEF OR NOT GETTING IT AROUND TRAFFICKING WITH YOUNG MEN AND BOYS, SO IF
THE PERSON ASKING THE QUESTIONS DOESN’T EVEN THINK THIS COULD BE HAPPENING TO A YOUNG MAN,
OR TO A BOY, DOES THAT KIND OF, OH, I’M SORRY, I HAVE TO ASK THESE QUESTIONS, THEY MAKE ME
DO IT, RIGHT? THAT IMMEDIATELY SETS OFF THE YOUNG PERSON
KNOWS THIS IS NOT A SAFE PERSON FOR ME TO TALK ABOUT THIS WITH OR EVEN BE SEEN AS DOING
IT, SEEING A YOUNG WOMAN WITH A NEW iPHONE, THAT SENDS OFF A RED FLAG, A MAN WITH A NEW
iPHONE, IT DOESN’T, RIGHT? THAT’S REALLY IMPORTANT. AND THAT MEANS WHO WE HAVE DOING ASSESSING,
HIRING PEOPLE, TRAINING THEM, WE HAVE TO ASK THOSE HARD QUESTIONS AND TEST THEM, SEE THEM
IN ACTION. SOMETIMES WE HIRE PEOPLE AND PUT THEM ON THE
FLOOR AND HAVE THEM DO THEIR THING AND WE’RE SO HAPPY THEY ARE WILLING TO WORK FOR SUCH
OWE LOW PAY IN OUR PROGRAM. YES! THEY PASS THE BACKGROUND CHECK! BUT IF YOU DON’T SEE THEM IN ACTION YOU DO
NOT KNOW WHAT NEAR COMFORT LEVEL IS, RIGHT? AND FINALLY WHY ARE WE ASSESSING? FOLKS HAVE TOUCHED ON THIS A LOT.
IS IT GOING TO CHANGE ANYTHING ON HOW WE DELIVER SERVICES TO THIS YOUNG PERSON? IF IT’S NOT, WHY GO THERE? AND I WOULD JUST SAY AROUND MANDATORY REPORTING,
REALLY UNDERSTANDING YOUR STATE’S LAWS AND UNDERSTANDING YOUR PLACE YOU WORK FOR, WHAT
PROTOCOLS SOMETIMES WE THINK PROTOCOL IS LAW, AND IT’S NOT, RIGHT? FOR EXAMPLE, IN NEW YORK STATE, AT LEAST IN
ROCHESTER, MONROE COUNTY, OUR DSS FOLKS IN A YOUNG PERSON HAS RUN FROM PLACEMENT OR FOSTER
HOME WE’LL OFTEN REQUIRE THAT YOUNG PERSON TO HAVE A MEDICAL EXAM IF THEY THINK THERE’S
BEEN SEXUAL ACTIVITY WHILE THEY WERE OUT. AND THE PROVIDER, HEALTH CARE PROVIDERS DOES
THAT. BUT YOUTH DOESN’T HAVE TO DO IT. A MINOR, MATURE MINOR CAN DENY THAT KIND OF
EXAM, BUT NOBODY TELLS THE YOUNG PERSON THAT, RIGHT? WE THINK IT’S LAW, WE THINK THEY HAVE TO. THE MEDICAL PROVIDER THINKS THEY HAVE TO. LIKE THE LAWYERS FOR THE MEDICAL PROVIDER
THINK THEY HAVE TO, RIGHT? SO WHEN YOU DIG INTO SOMETHING, YOU FIND OUT
THAT’S NOT NECESSARILY THE TRUTH AND AS A MEDICAL PROVIDER YOU MIGHT BE ENGAGING IN
MORE TRAUMATIZING THAT YOU DIDN’T EVEN KNOW YOU HAD A CHOICE NOT TO IF THE YOUNG PERSON
DIDN’T WANT TO DO IT. THE NEXT SLIDE I’M GOING TO SHOW, I SHARE
IT BECAUSE I THINK IT’S KIND OF THE BIG GORILLA IN THE ROOM IN TERMS OF WHY WE NEED TO ASSESS,
WHY WE’RE SCREENING, WHY PEOPLE AREN’T TELLING US THIS IS A FRIENDLY ROOM, WE’RE ALL SEEMINGLY
INTERESTED AND COMPASSIONATE ABOUT THIS. SO IF IT’S HARD TO READ I APOLOGIZE AHEAD
OF TIME. THIS IS STUFF WE HEAR PEOPLE SAY WHEN WE’RE
WORKING WITH THIS POPULATION. SO THIS LESSON WAS SUPER BITTER FOR US, THAT
PEOPLE IN HELPING PROFESSIONS STILL THINK LIKE THIS. EVEN AFTER ALL THE TRAINING WE’VE DONE, SO
IT MEANS WE HAVE TO BE EXTRA HARD WHEN WE’RE IF WE’RE ASSESSING AND SCREENING AND MAKING
REFERRALS, WHY AND WHO ARE WE MAKING IT TO, ARE WE SURE THEY WON’T SAY SOMETHING LIKE
THIS, THEY ARE NOT GOING TO THINK SOMETHING LIKE THIS, BECAUSE WE KNOW YOUNG PEOPLE HAVE
BEEN THROUGH TRAUMA, THEY DON’T CARE WHAT YOU SAY, IT’S HOW YOUR BODY LOOKS, RIGHT? IF YOU’VE GOT A SCREW FACE OR BODY LANGUAGE,
WHAT IS THIS YOUNG PERSON TELLING ME? I’M THE ONLY PERSON WITH CARTOONS. SO THIS IS ONE THAT’S REALLY HARD FOR FOLKS
TO LEARN, PEOPLE HAVE AUTONOMY, EVEN YOUNG PEOPLE. WE THINK WE CAN MAKE RULES, WE THINK WE CAN
KEEP THEM SAFE, IF WE TELL THEM TO DO THIS. IF THEY DO IT, IT’S BECAUSE THEY CHOOSE TO
DO IT. WE HAVE TO REALLY HONOR THAT BASIC LEVEL OF
HUMAN INTERACTION, IT SEEMS LIKE COUNTER PRODUCTIVE, WE WORKED WITH LAW ENFORCEMENT FOR A LONG
TIME, THE EARLY DAYS OF OUR SAFE HARBOR PROGRAM WHEN YOUTH WOULD HANG UP ON THEM AND LAW ENFORCEMENT
WOULD CALL BACK, WHAT THE HELL JUST HAPPENED, THAT’S NICER LANGUAGE THAN THEY USED WITH
US, WE WOULD SAY THIS YOUNG PERSON HAS THE CHOICE WHETHER OR NOT TO TALK TO YOU BUT WE’RE
STILL GOING TO KEEP OUR RELATIONSHIP WITH YOU.
AND THAT NEED TO THAT AUTONOMY, WHEN RISK OR ANXIETY GOES UP WE WANT TO CONTROL, RIGHT? SO THAT’S REALLY NORMAL. WHAT HAPPENS, YOUNG PEOPLE DON’T SEE THEIR
ANXIETY OR RISK OF US TRYING TO CONTROL THEM THEY REBEL AGAINST INSTEAD OF THINKING WE’RE
HELPING THEM, THEY MOVE AGAINST US, YOUNG KIDS ONE RUN AWAY FROM FOSTER CARE, FROM OUR
SERVICES, SO IT’S REALLY IMPORTANT WHEN THEY COME BACK AND RETURN TO US THAT WE’RE HAPPY
TO SEE THEM. I HAVE ANOTHER SLIDE, YOU HAVE TO SEE DILBERT,
RIGHT? BUT THIS IS WHAT HAPPENS, RIGHT? IF YOU HAVE TONS OF PAPERWORK TO DO, THAT
YOUNG PERSON HAS COME BACK, RUN FROM FOSTER CARE FOR THE TENTH TIME, STAFF ARE LIKE HERE
WE GO AGAIN, RIGHT? THAT’S A GOOD THING THEY HAVE COME BACK. IF OUR SYSTEMS ARE INTOLERANT AND CREATE PHONE
CALLS AND E MAILS AND REPORTS, THAT COMES DOWN IN THAT MOMENT WHEN THAT PERSON HAS THAT
FIRST ENGAGEMENT WHEN THEY RETURN. IT’S ALL IN THAT PERSON’S FACE, ALL IN THEIR
BODY. CAN I BUY ANOTHER MINUTE TO GIVE A STORY? IT’S A HEALTH CARE STORY. SO, AN EXAMPLE, WE HAD A YOUNG WOMAN IN SAFE
HARBOR, 15 WHEN WE MET HER. OUR COUNTY, WE’RE TRYING TO GET HER IDENTIFIED
AS DESTITUTE CHILD. COUNTY FOLKS SAID SHE’S NOT, SHE’S GOT A MOTHER
WHO CAN PLAN FOR HER. GREAT. WHERE IS SHE? SHE’S A FEDERAL FUGITIVE, ON THE RUN. OKAY. SO WE FOUGHT WITH THEM, GOT HER INTO FOSTER
CARE, SHE’S JUST GOING TO RUN. YOU DON’T KNOW THAT. GOT HER INTO FOSTER CARE, SHE RAN IMMEDIATELY. TOOK OFF FOR LIKE SIX MONTHS, CAME BACK, YAY,
RIGHT? RAN AGAIN. WHILE SHE WAS ON THE SECOND RUN, SHE REACHED
OUT TO US, SHE NEEDED HEALTH CARE. SHE CALLED US AND SAID I WANT TO COME BACK
INTO HEALTH CARE. I WANT TO GO BACK TO THE FOSTER CARE HEALTH
CARE SITE, I HAD A GOOD EXPERIENCE, WANT TO GO BACK. FOSTER CARE WORKER WOULD NOT GIVE HER THE
INFORMATION TO ACCESS UNTIL SHE TURNED HERSELF BACK IN TO FOSTER CARE. OKAY. WE WERE MIND BOGGLED. SHE SAID OKAY, I’LL GOING TO THE EMERGENCY
ROOM AND USE A FAKE NAME. SHE USES A FAKE NAME. THE COUNTY CALLED ALL THE EMERGENCY ROOMS
IN THE AREA, DESCRIBED HER, AND DEMANDED THEY CALL THE FOSTER CARE FOLKS IF SHE SHOWS UP. WHICH THEY DID. THEY SENT THE POLICE. AND I HAVE TO SAY THE POLICE WERE THE MOST
TRAUMA INFORMED. EVERYONE WAS TELLING HER SHE HAD TO TAKE A
SHOT, WE WAS SCARED OF PULLING HER PANTS DOWN IN FRONT OF THE OFFICER. HE STEPPED OUT. I THINK YOU GOT THIS, AND WALKED OUT. EVERYBODY IN THE SYSTEM WAS DOING WHAT THEY
THOUGHT THEY WERE SUPPOSED TO BE DOING BY LAW. SHE CAN’T BE TRUSTED TO GET HEALTH CARE. SHE CAN’T BE TRUSTED TO TAKE THE ORAL MEDICATIONS
WE’RE GOING TO GIVE HER A SHOT EVEN THOUGH SHE’S AFRAID OF NEEDLES. SO ON THE OTHER END FROM HER PERSPECTIVE IT
WAS A HOT MESS. ULTIMATELY, REALLY THINKING ABOUT SCREENING
AN ASSESSING, WHAT’S THE POINT, ARE WE GOING TO ADDRESS THE THINGS THAT KEEP THE YOUNG
PEOPLE VULNERABLE TO TRAFFICKING IF THEY STEP OUT FOR A BIT, ARE THOSE VULNERABILITIES STILL
THERE? EVEN IF THEY GO THROUGH A TRIAL, TRAFFICKER
GETS CONVICTED, IS THEIR LIFE BETTER, DO THEY HAVE HEALTH CARE, HOUSING, EDUCATION, ALL
OF THAT STUFF. I TOOK MY THANK YOU. SORRY. [APPLAUSE]>>THANK YOU SO MUCH FOR ALL OF YOUR PERSPECTIVES
AND THE INSIGHTFUL CONVERSATIONS THAT WE’RE GETTING READY TO HAVE. I’M LOOKING FORWARD. DO WE HAVE ANY QUESTIONS FROM ANYONE IN THE
AUDIENCE? WE HAVE A MIC RIGHT THERE. I ALSO HAVE SOME PRE ASKED QUESTIONS RIGHT
HERE ON THE CARD. THIS IS FOR EVERYONE. THERE’S SUCH A FOCUS ON SEX TRAFFICKING WHEN
WE TALK ABOUT SCREENING AND RESPONSE. WHAT ARE SOME OF THE DIFFERENCES YOU CONSIDER
WHEN WORKING WITH INDIVIDUALS YOU SUSPECT OF LABOR TRAFFICKING?>>ANYONE CAN ANSWER.>>I THINK I DON’T SO MUCH THINK OF WHEN I’M
WORRIED ABOUT A PERSON, I’M NOT THINKING ABOUT WHAT THE THING IS, SEX OR LABOR, I’M JUST
WORRIED THEY ARE HURT AND IN DANGER. THAT’S WHERE I START. BECAUSE I DON’T HAVE A SCREENING TOOL THAT
I CAN USE IN THE CLINICAL SETTING THAT’S COMPREHENSIVE BECAUSE PEOPLE ARE TRAFFICKED IN MULTIPLE
WAYS, IN SERIES AND PARALLEL, RIGHT? MY FIRST THING IS THEY ARE HERE FOR HEALTH
CARE, LET’S DO THAT. LET’S FOCUS ON THAT. A LOT OF PRINCIPLES THAT WE TALKED ABOUT THAT
WE TOUCHED ON FIND A WAY TO GET THEM ALONE AT SOME POINT, THAT FEELS NATURAL, LIKE THE
OTHER PERSON WITH YOU CAN’T ALSO GET THEIR X RAY, IT’S NOT PICTURED DAY FOR EVERYONE. IT’S JUST ME AND SO AND SO. WE GO TOGETHER. AND THEN I FIND OUT MORE ABOUT WHAT HAPPENED,
WHAT BROUGHT THEM IN, WHY TODAY, WHY IS TODAY SPECIAL, WHY NOT YESTERDAY OR TOMORROW, OPEN
ENDED QUESTIONS, THE ANTITHESIS, THEY AREN’T AS PAINFUL. IT DOESN’T TAKE MORE THAN FIVE MINUTES IF
SOMEONE IS GOING TO TELL ME. IF THEY AREN’T READY TO TELL ME IT’S PERFECTLY
ACCEPTABLE FOR ME TO SAY I’M WORRIED ABOUT YOU, I THINK SOMETHING BAD IS HAPPENING TO
YOU, I DON’T KNOW WHAT, I’M GLAD YOU CAME HERE TODAY FOR THIS, I HOPE YOU’LL COME BACK
WHEN YOU’RE READY FOR XYZ MORE AND MAYBE I GIVE THEM MY CARD, IT DOESN’T SAY ANYTHING
MORE THAN I’M A DOCTOR. IF THEY CAN’T ACCEPT THAT I’M SPECIAL LIP
CONCERNED. I’M OPEN 24/7. I REPRESENT YOU. I VEER FROM THE SCREENING, I DON’T HAVE THAT
CAPACITY RIGHT NOW. AND AIM MORE TOWARDS A HOLISTIC ASSESSMENT
OF SOMETIMES THEY CAME FOR A SANDWICH, SOMETIMES I HAVE TO ORDER BUFFALO WINGS BECAUSE WE DON’T
HAVE A SANDWICH BUT YOU GET IT DONE.>>ANYONE ELSE? YEAH, WE DON’T COME FROM THE SILO CONTEXT
OF SEX TRAFFICKING ALONE. WE TRAIN AND TALK ABOUT THIS ISSUE FROM THE
BROADER PERSPECTIVE OF EXPLOITATION, SO WHEN I WORKED WITH CRC IN THE WORK WE DO AT THE
LAB, QUITE FRANKLY MANY COLLEAGUES IN THE COLORADO ANTI TRAFFICKING MOVEMENT AND NATIONALLY,
WE OPEN THAT CONVERSATION AND DIALOGUE AROUND EXPLOITATION AND SOME OF THE DIFFERENT NUANCES
BETWEEN SEX AND LABOR BUT OFTEN WE’RE TALKING ABOUT THOSE IN THE SAME EXPERIENCE, RIGHT? MANY FOLKS THAT WE’VE COME ACROSS AND FOLKS
I HAVE GREAT RELATIONSHIP WAS HAVE BEEN TRAFFICKED FOR SEX AND LABOR IN THE SAME EXPERIENCE. SO WE TRY NOT TO SPLIT THOSE TWO SPACES UP. WE DO THAT THROUGH TRAINING, WE DID THAT THROUGH
OUR CONVERSATIONS, WE DO THAT THROUGH OUR CAPACITY AND COALITION IN THE STATE. WE DO HAVE SPACES WHETHER FOLKS ARE PRIMARILY
EITHER FUNDED OR MANDATED TO BE LOOKING AT SPECIFIC TYPE OF CRIME. BUT WE ARE NEVER LOOKING AT SEX TRAFFICKING
IN AND OF ITSELF IN A SILOED BECAUSE WE LOSE PEOPLE, LOSE CONVERSATIONS, LOSE NUANCE AND
OPPORTUNITY TO SUPPORT SOMEONE WHEN WE DO THAT.>>WENDY, I’M GOING TO DIRECT THIS ONE TO
YOU AND OTHERS WHAT TYPES OF ORGANIZATIONS ARE PART OF YOUR RESOURCE DIRECTOR, CAN THERE
BE A DESIGNATED POINT OF CONTACT, HOW IS THIS RESOURCE DIRECTORY UPDATED, IS THERE A DEDICATED
STAFF MEMBER WHO UPDATES THE DIRECTORY AND HOW OFTEN?>>THAT’S ME.>>IT’S LANDERHOLM.>>THAT’S ME. WE’RE TALKING ABOUT THE COLORADO NETWORKS
TO END HUMAN TRAFFICKING HOTLINE. WHAT WERE THE QUESTIONS THEY WERE ASKING? THERE WAS A LOT ON THAT.>>SO THE FIRST IS WHAT TYPES OF ORGANIZATIONS
ARE IN THE DIRECTORY, IS THERE A DIRECTORY WHERE SERVICE PROVIDERS HAVE A DESIGNATED
POINT OF CONTACT.>>OUR DIRECTORY IS VETTED, 300 RESOURCES,
A STAFF MEMBER, KAREN NAPOLITANO, IF YOU WOULD WAVE, FIND HER AFTER THE CONVERSATION, ADVOCATES
ARE TRAINED OVER 50 HOURS TO ANSWER PHONES. WE HAVE MULTITUDES OF SERVICE PROVIDERS, LAW
ENFORCEMENT, PRO BONO, HEALTH, LEGAL, WE HAVE MICHELLE MATSON IN THE AUDIENCE, A NURSE FROM
THE LOCAL HOSPITAL, COLLABORATIVE THROUGH THE HEALTH CARE SETTING, TONS OF DIFFERENT
TYPES. IT’S STATEWIDE SO IT’S NOT ONLY OUR SPECIFIC
RESOURCE SUCH AS DENVER, THEY ARE IN ALL LOCALES AND RURAL, ALSO CONNECTED TO OUR TRUSTED LAW
ENFORCEMENT AGENTS THROUGH FBI, STATE PATROL COLORADO COUNCILMAN DATED BY THE GOVERNOR,
A BROAD RANGE OF SERVICES. A THIRD HAVE LIVED EXPERIENCES, WE GET CONTACTS
FROM FOLKS IN THE MOVEMENT, SERVICE PROVIDERS, AND DIRECTLY CONTACTED BY FOLKS WITH LIVED
EXPERIENCE IN THAT MOMENT. AND DEPENDING ON THEIR AGE, ANYONE UNDER 18
WE’LL CONNECT WITH LAW ENFORCEMENT, OVER AGE THAT’S A CONVERSATION WE’RE GUIDED BY THE
PERSON ON THE OTHER END OF THE LINE WHAT THEY WISH TO DO, TRANSLATORS, WHOLE NINE YARDS.>>THANK YOU. THIS IS FOR EVERYONE. HOW DOES SCREENING ASSESSMENT FOR LABOR TRAFFICKING
LOOK THE SAME OR DIFFERENT, WHAT HAVE YOU LEARNED FROM THE COMMUNITY, IS IMMIGRATION
STATUS A BARRIER? AND I CAN REPEAT ALL THE QUESTIONS.>>MY QUICK ANSWER FOR THE LAST PART IS WE
HAVE SEEN IMMIGRATION STATUS HAS IMPACTED WHO IS COMING FORWARD, JUST THE CLIMATE CHANGE
AND HOW THAT’S APPROACHED AS WELL HAS IMPACTED OUR ABILITY TO CONNECT AND OUTREACH WITH YOUNG
PEOPLE TO COME THROUGH THE PROGRAMS AND ACCESS SERVICES. IN TERMS OF HOW IT’S THE SAME OR DIFFERENT,
WE’RE COMING FROM OUR SERVICES, RUNAWAY AND HOMELESS YOUTH, THE MAIN ISSUE AND WE DIVE
INTO OTHER THINGS. IF IT’S LABOR TRAFFICKING THAT WILL COME THROUGH
THE RELATIONSHIPS AND THOSE CONNECTIONS, OR IT’S VERY SIMILAR AND HOW WE GET THERE BUT
WE’VE SEEN LESS YOUNG PEOPLE WILLING TO COME FORWARD DEFINITELY.>>THANK YOU. ANYONE ELSE?>>FOR THE HEALTH CENTERS WE WORK WITH, WE
ENCOURAGE THEM TO POST SIGNS IF THEY DON’T ASK ABOUT IMMIGRATION STATUS, PUT THAT UP
IN THE LOBBY. SO BECAUSE COMMUNITY MEMBERS SEE THAT AND
TELL OTHERS, THOSE KINDS OF THINGS, SO INCREASING ACCESS THAT WAY. I ALSO WANT TO SAY ONE POINT TO THE PREVIOUS
QUESTIONS. UNFORTUNATELY A LOT OF HEALTH CARE PROVIDERS
MAY NOT HAVE RECEIVED EDUCATION OR TRAINING ON THESE TOPICS. IPV, HUMAN TRAFFICKING IN SCHOOL. IT’S IMPORTANT TO PROVIDE SOME TRAINING AND
EDUCATION BUT TO DO IT IN PARTNERSHIP WITH EXPERTS FROM THE COMMUNITY, SURVIVORS, DOMESTIC
AND HUMAN TRAFFICKING PROGRAMS, TO HAVE THEM COME IN. IT REALLY REDUCES BARRIERS FOR HEALTH CARE
PROVIDERS TO MEET THEM IN THE ROOM, AND TO INVOLVE THE WHOLE STAFF IN THAT TRAINING BECAUSE
SOMETIMES IT’S THE MEDICAL ASSISTANT OR RECEPTIONIST WHO WILL BE MORE AWARE OR HAVE A RELATIONSHIP
WITH THOSE PATIENTS, TO BE ABLE TO HAVE A CONVERSATION OR IMPART LITERATURE, RESOURCES. WHEN WE TALK ABOUT BEING TRAUMA INFORMED,
GOING BACK TO LABOR TRAFFICKING PIECE, WE HAVE TO BE READY FOR OUR PATIENTS’ LIVES ARE
COMPLEX, WE HAVE TO HEAR WHAT THEY ARE SAYING. DR. CHANG TOLD ME HOW CRITICAL SOCIAL HISTORY
PORTION IS OF THE VISIT SO WHEN YOU ASK SOMEONE DO THEY HAVE ENOUGH TO EAT, WHERE DO THEY
LIVE, IS THERE RUNNING WATER, HOW MANY PEOPLE LIVE WITH THEM, WHAT DO THEY DO FOR WORK,
ARE THEY EXHAUSTED, A YOUNG PERSON EXHAUSTED GOING TO SCHOOL. SOMETIMES FILLING IN A PORTRAIT, ASKING QUESTIONS,
SOCIAL INTAKE HISTORY QUESTIONS REALLY HELP YOU INFORM YOU OF MAYBE SOME COMPLEXITY GOING
ON IN YOUR PATIENT’S LIFE. THEY MIGHT NOT BE READY TO FULLY DISCLOSE
AND MIGHT BE FEARFUL IN TERMS OF THREATS MADE TO THEM, IF THEY DO TALK ABOUT WHAT’S GOING
ON BUT I THINK THERE’S OTHER WAYS BY BEING TRAUMA INFORMED WE CAN STILL BE RECEPTIVE
AND STILL GIVE THEM INFORMATION AND RESOURCES EVEN IF THEY REALLY CAN’T TALK SPECIFICALLY
ABOUT WHAT’S GOING ON.>>THANK YOU VERY MUCH. SO UNFORTUNATELY THAT CONCLUDES OUR TIME FOR
THE Q&A. I WANT TO THANK OUR PANELISTS FOR YOUR PRESENTATIONS
REGARDING SCREENING AND STRATEGIES AND CHALLENGES AND RECOMMENDATIONS TO APPROACHES AND TOOLS
THAT YOU ALL HAVE SUCCESSFULLY USED AND WE’RE GRATEFUL FOR YOUR COMMITMENT TO THIS COMMUNITY
AND TO THE WORK YOU ALL CONTINUE TO DO IN ANTI TRAFFICKING. THANK YOU VERY MUCH. [APPLAUSE]

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