Medical Treatment of Victims of Sexual Assault and Domestic Violence and Its Applicability to Victims of Human Trafficking. The Importance of Training


All healthcare providers and non-healthcare providers working in healthcare settings should be trained in proper screening techniques for victims of human trafficking as well as domestic violence.  Despite the need for training, a dearth of knowledge exists regarding how many healthcare practitioners have been trained to accurately identify, examine, and treat victims of domestic violence and sexual assault (AHRQ, 2003).  For example, one study found that while 88 percent of physicians acknowledged having female patients who were victims of abuse, only 6 percent routinely asked their patients about possible domestic violence (Elliott, Nerney, Jones, & Friedmann, 2002).

Healthcare providers report not screening for domestic violence because they feel that they do not possess the necessary training, time, skills, and resources to care for victims (Elliott et al., 2002).  In another study, more than 25 percent of physicians and almost 50 percent of nurses and medical assistants reported not having any confidence in their ability to screen for physical abuse.  This same study found that only 23.9 percent of physicians, nurses, and medical assistants felt that they possessed strategies to assist victims of domestic violence (Sugg et al., 1999).  Lack of training results in misconceptions among healthcare providers, hindering identification of and service provision to victims (Institute for Clinical Systems Improvement, 2006).  Without proper training on human trafficking and other forms of violence, abuse and exploitation, erroneous beliefs regarding this population of victims are likely to be perpetuated as well.

Training Content

The goals of training on domestic violence, sexual assault, and human trafficking should center on increasing awareness about the problems and the internal and external resources available to support comprehensive service delivery. While, most training programs offer a broad overview of sexual assault and/or domestic violence focused on identification, management, and referral of victims (AHRQ, 2003), training should also teach skills and identify barriers to identification and treatment (Institute for Clinical Systems Improvement, 2006).  Skill development is especially important in terms of interview techniques, safety assessment, and documentation.  Similarly, training on human trafficking must offer healthcare providers and others in the healthcare field information and practical skills that can be used to identify, assess, and treat victims of human trafficking.

Training for healthcare providers on evidentiary examinations is required to ensure exams are conducted correctly and with rigor that will stand up in a court of law.  The growing number of programs and training in forensic science can be credited to expanded State reporting requirements.  A few States, such as Alaska, California, Florida, Iowa, Kentucky, and New York, have established mandatory education requirements for healthcare professionals on intimate partner violence, child abuse, and/or sexual assault.  But most of these requirements focus on reporting incidents as opposed to enhancing clinical skills (AHRQ, 2003).  Current training programs on related issues can be evaluated to assess the potential of incorporating the issue of human trafficking into training programs already focused on domestic violence, intimate partner violence, and child abuse.  Such evaluation can provide a platform to compare and contrast different forms of sexual and physical violence while reducing redundancy in training.

There has been little examination of current trainings on domestic violence and sexual assault to assess their content, duration, and scientific basis (AHRQ, 2003).  However, one study found that training physicians in identification and treatment of domestic violence increased their screening from 3.5 percent to 20.5 percent.  (Thompson et al., 2000).  Further assessment of domestic violence and sexual assault trainings is imperative to understand their impact on identifying and treating victims of domestic violence as well as the expected success of incorporating human trafficking.

The Role of Academic Programs, Hospitals, and Medical Associations

One way to ensure successful training of healthcare professionals is to integrate sexual assault, domestic violence, and human trafficking curricula into university and other educational programs.  While some programs currently provide a broad overview on the issues of sexual assault and domestic violence, only a few university-based healthcare training programs integrate content on performing medical evidentiary examinations.  Additionally, the International Organization on Migration concluded that the programs that do exist are often inadequate (IOM, 2006).  To improve university-based training, the Health Resources and Services Administration and other agencies within the U.S. Department of Health and Human Services have begun collaborating with nursing schools to develop and implement improved curricula on issues related to violence against women (AHRQ, 2003).

In 1982, the Presidents Task Force on Victims of Crime recommended that all hospitals implement the following: provide training to all hospital personnel sensitizing them to the needs of victims of violent crimes, especially victims who have been sexually assaulted; offer emergency medical assistance to victims of violent crime regardless of their ability to pay; provide emergency room crisis counseling; develop relationships with all victim assistance and social service agencies in their communities; and work with prosecutors to develop a standardized rape kit (Office for Victims of Crime, 1998).

The Joint Commission on Accreditation of Healthcare Organizations, a nonprofit organization that evaluates and accredits more than 17,000 hospitals, healthcare networks, and other healthcare organizations in the United States, has adopted guidelines requiring that member hospitals and organizations have objective criteria for identifying victims of physical assault, sexual assault, domestic violence, and abuse of elders and children.  Members must train staff on identification and maintain a list of referral organizations that provide assessments and care for victims (AHRQ, 2003).  In an attempt to standardize care, the Delphi Instrument for Hospital-based Domestic Violence Programs features 37 performance measures in nine categories and assesses the programs physical structure as well as the providers process of care (Kass-Bartelmes & Rutherford, 2004).  This tool provides a solid foundation for development of a similar tool for human trafficking.

Several professional organizations and accreditation bodies have developed clinical protocols, policies, professional standards, training materials, and courses related to domestic violence and/or sexual assault.  These professional organizations include the American College of Obstetricians and Gynecologists, American Medical Association, American College of Emergency Physicians, American Professional Society on the Abuse of Children, and the Centers for Disease Control and Prevention.  The National Health Initiative on Domestic Violence, through the Family Violence Prevention Fund, developed a training program that has been used in more than 100 hospitals (Office for Victims of Crime, 1998).  In 2003, AHRQ identified 72 unique sexual assault training programs, policy statements, and protocols related to healthcare providers and practices.  By incorporating human trafficking into these training programs, healthcare providers can learn about the similarities and differences in identifying, examining, and treating victims of human trafficking when compared to victims of other forms of sexual assault.  Additionally, the healthcare providers who attend these trainings are the same healthcare providers who would benefit from training on human trafficking.  Providers who see victims of domestic violence and sexual assault are often also serving victims of human trafficking regardless of whether or not they are aware of this; training them to recognize and treat the specific needs of human trafficking victims is a critical step to effective care for this population.

Current Training on Human Trafficking Aimed at Healthcare Professionals

The majority of trainings designed to educate medical professionals on human trafficking provide a broad overview of the issue and its proper identification. The Rescue and Restore Campaign in conjunction with the National Human Trafficking Resource Center offers toolkits, phone consultations, and in-person trainings for healthcare practitioners to improve their understanding and identification of human trafficking.  The Christian Medical & Dental Association also offers an online introduction to human trafficking course for which medical professionals can receive continuing education credits.  In addition to these nationally recognized training programs, other anti-trafficking organizations provide trainings to healthcare professionals.

As with sexual assault and domestic violence, more targeted training is needed to enhance skills and recognize barriers to identification and treatment. According to service providers working with victims of human trafficking, the shortage of this targeted training may be due, in part, to the limited number of qualified medical professional trainers available (Williamson, Dutch, & Clawson, 2008).

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