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BackTable / OBGYN / Article
How to Identify Human Trafficking in Healthcare Settings & How to Respond
Faith Taylor • Updated Mar 17, 2025 • 34 hits
Healthcare providers are uniquely positioned to identify and support human trafficking survivors. This patient population is subject to a heightened risk of certain medical conditions, including sexually transmitted diseases, injuries, and poor pregnancy outcomes, all of which require medical care. Human trafficking survivors may also turn to healthcare settings when they have nowhere else to go. In either case, detecting and responding to potential trafficking cases can be challenging for healthcare providers, often leading to delayed or insufficient care for these patients.
In this article, Dr. Julia Geynisman-Tan, OBGYN and founder of the Northwestern ERASE Clinic for Survivors of Human Trafficking, uses her extensive expertise and experience in this field to outline the key signs that a patient is a survivor of human trafficking. She also shares strategies to effectively respond to human trafficking cases, and explains how to build trust with patients to improve care and support for survivors.
This article features excerpts from the BackTable OBGYN Podcast. We’ve provided the highlight reel in this article and you can listen to the full podcast below.
The BackTable OBGYN Brief
• Trafficking survivors may present with a history of domestic and/or sexual violence, recurrent STIs, poor pregnancy outcomes, and/or tattoos linked to control or exploitation, such as sexual, gang, or financial symbols. More subtle signs of trafficking include frequent clinic changes, inconsistent histories, anxiety, or story discrepancies.
• Hospitals and providers can enhance their ability to identify and support trafficking survivors by adopting structured protocols like those from Health Education Advocacy Linkage (HEAL).
• The HEAL protocol targets patients with human trafficking risk factors and includes questions about living situations, control over documents, and safety concerns.
• When a patient discloses trafficking, providers should follow established protocols for notifying law enforcement, ensuring the patient’s safety, and connecting them with appropriate support services.
• Conversations with suspected trafficking patients should be conducted in secure environments, away from potential traffickers, to ensure patient safety.
• Clinicians can build trust with patients suspected of being involved in trafficking by creating a supportive, non-judgmental environment.
Table of Contents
(1) How to Identify Human Trafficking in the Clinic
(2) Adopting Protocols for Identifying & Supporting Trafficking Survivors
(3) Addressing Suspected & Disclosed Trafficking
How to Identify Human Trafficking in the Clinic
Healthcare providers play a critical role in identifying and supporting survivors of human trafficking, yet the signs can vary in visibility. Some indicators are more apparent, such as a history of domestic or sexual violence, recurrent sexually transmitted infections, poor pregnancy outcomes, or tattoos with explicit sexual, gang-related, or financial symbols. While these factors are important to keep in mind, trafficking victims may also present with more subtle cues. Patients who frequently change clinics, provide inconsistent histories, or remain on their phones throughout exams may warrant closer attention. Discrepancies in their story, especially when details change between conversations with different providers, can also be indicative of trafficking. Emotional cues, such as unease or anxiety during a routine encounter, may further reflect the patient’s distress. Recognizing both the overt and subtle signs can help providers offer appropriate support and resources, improving care for trafficking survivors within routine clinical practice.
[Dr. Amy Park]
Tell me in terms of your clinical work, how can we as OBGYNs, as physicians, or just in the healthcare setting, how can we find out or just have a spidey sense that a patient may be a victim of, or I don't know what the right word is, but just that human trafficking may be a part of the situation or the story?
[Dr. Julia Geynisman-Tan]
It's funny that you bring up what the right word is. I go myself back and forth between victim and survivor. I think when I'm talking with patients about it, I tend to use the word that they use. Oftentimes they use the word survivor because even if they are still in the life, they are surviving it. When they have left the life, they have survived it, but many of them bounce back and forth. That's really not uncommon for both sex and labor trafficking. Where people find themselves in situations where for a period of time, they might need to go back and forth.
In terms of the spidey sense, I think there are all kinds of risk factors and all kinds of historical things in their presentation that perk up my ears a little bit. Certainly, people who have moved around a lot to, they don't have continuity of care at your healthcare system, they are always in different clinics, emergency rooms, their records are from all over. People who present with a story that's a little disjointed or that changes with each person who asks them. Like the medical student goes and interviews them and they tell you a story and then the resident goes and sees them and the story is a little different. Then when you go in, it's a little bit different.
The nurse gives you some different aspect. Usually, that's because they either themselves are unsure of some of the details or they've revised the story in their heads to tell each person as they realize that actually maybe something that I said could get me in trouble or is unsafe or they're going to figure out what's happening and I need to revise things. That perks up my ears. I will say that one of the things that always makes me a little suspicious is somebody who's on their phone throughout the entire visit.
The history taking, the physical exam, they're just constantly texting with somebody to give them updates, particularly during the physical exam. If you can't put your phone down for a second to do all the things we typically do in a abdominal and pelvic gynecologic exam, it makes me a little concerned. Then a lot of it has to do with just their general demeanor. I always talk about this counter-transference that I think we all learned about in our psych rotations back in the day that our patients transfer energy back to us, their mood, their feelings in the room.
If you just took care of a patient that you've got this great rapport with, you felt like you were on your game, you had a great conversation, and then suddenly you walk into this room with this patient and you start feeling anxious and you're not really sure who's miscommunicating with who and why are they upset? Why am I suddenly upset? Why are we in a disagreement about this? That feeling of they are really anxious about something and it's making me anxious, I try to lean into that.
I know that I'm the professional there giving the best possible advice. I'm asking all the right questions, but if I'm feeling uneasy, it's probably because they're uneasy and I need to ask more about why that is. All of those are my spidey sense things. We're all taught this stuff about, ask about histories of domestic violence and sexual violence, to look for people with repetitive sexually transmitted infections, with poor pregnancy outcomes, with tattoos that have very explicit sexual messages or gang symbols or financial symbols. All those things are great to have in the back of your mind.
There are very few patients where you'll be like, "Ding, ding, ding, ding, ding, ding. It checks all those boxes." It's usually a lot more subtle.
[Dr. Amy Park]
By the way, I was just curious, how do these patients make their way to your clinic?
[Dr. Julia Geynisman-Tan]
A couple of different ways. I work with the emergency room and with our OBGYNs and primary care doctors a lot here, and they know that my clinic exists. When they see a patient that they think may have been a survivor of trafficking, they might just call me up for a curbside consult. "Hey, I'm seeing this. Does this sound weird to you? What resources should I provide them with?" Sometimes they want me to see them and take over their care. Then that's what I do.
Other times I'm seeing people who are not actually here at our health system yet, but they have already engaged with law enforcement or social work or with some community partner. That partner reaches out to me and says, "Hey, I have somebody that was brought in by law enforcement. I'm working with them on a T visa or on their housing placement or whatever it is. By the way, she needs some STI testing or she hasn't had a pap smear in five years or whatever it is, could her?" I get referrals from all over. Honestly, sometimes patients just call me up out of the blue. They find my website and they call.
[Dr. Amy Park]
How can health professionals, specifically OBGYNs, but any health professional help in combating the human trafficking?
[Dr. Julia Geynisman-Tan]
I think the way I think about my clinic in this whole role is I would like to put myself out of business in the next five years. There shouldn't have to be a human trafficking clinic because my hope is that all of us, as we go through our medical training and our experience as clinicians, we should learn about these signs. We should learn about how to take care of these patients. We should learn about how to refer them to the right social work and law enforcement resources. There shouldn't have to be a clinic like this, but we should all be trauma-informed. We should all be advocating for our patients.
I sort think about this like there used to be special HIV clinics in the 1990s that we've more or less gotten rid of these days. Everybody is seen by their primary care doctor and most, OBGYNs and MFMs take care of patients with HIV all the time. They don't need a special clinic. There are no special LGBT clinics per se anymore. We all take care of patients who are in any gender identity or sexuality spectrum. There shouldn't have to be a special human trafficking clinic. This should just be part of all of our continuity.
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Adopting Protocols for Identifying & Supporting Trafficking Survivors
Hospitals can improve their ability to identify and support trafficking survivors by adopting structured protocols, such as those recommended by the Health Education Advocacy Linkage (HEAL). HEAL offers adaptable resources that outline best practices for screening and response. The protocol Dr. Julia Geynisman-Tan utilizes, begins by identifying patients with risk factors rather than screening all individuals. It includes targeted questions about recent living situations, control over identification documents, and personal safety concerns. The protocol also emphasizes the importance of conducting these conversations in secure environments, away from potential traffickers. In cases where trafficking is disclosed, the protocol provides clear steps for contacting local law enforcement and FBI trafficking agents to ensure the patient’s safety and access to resources.
[Dr. Amy Park]
How can healthcare systems better support healthcare providers in identifying and assisting people who are in this situation of human trafficking, but it's also you are alluding to a lot of the state laws and a legal framework for it as well and social networks. It sounds like it's a very multidisciplinary process here to galvanize and support people where they're at.
[Dr. Julia Geynisman-Tan]
Absolutely. Our hospital has a human trafficking protocol that I wrote together with some other colleagues here at the hospital. Many hospitals have a protocol like that that probably your social workers and emergency room providers know best. There are examples of protocols like this through the HEAL website. HEAL is the Health Education Advocacy Linkage Group. It's a whole bunch of healthcare professionals who work on this nationally. There are example protocols that you can use and modify for your hospital.
We have a protocol that, goes through screening questions, that goes through response, which might include calling me or some other colleagues of mine here, and then where to reach out for resources outside of the hospital.
[Dr. Amy Park]
Since you're a subject matter expert in this arena, tell me what this protocol says.
[Dr. Julia Geynisman-Tan]
Yes, sure. The protocol first starts with identifying risk factors and who to be screening. We don't recommend that you screen every single person coming into the healthcare setting with these questions. The burden is too high. Luckily, the incidence of this is low enough that we don't need to screen everyone. If you do see a number of risk factors, which are laid out in the protocol, then we do some screening questions. A lot of them have to do with where did you sleep the last three nights. Is it the same place? Do you have control of the documents that you carry? Your ID card or passport or work visa, whatever it is, do you have control of that?
We ask about physical safety and whether anybody has asked you to carry a weapon for them or if you choose to carry a weapon to protect yourself against anyone. We have a whole screening questionnaire. We have a protocol around where to do this. Probably all of our emergency rooms have beds in the hallway and stretchers all over the place and things, and that is not the appropriate place to be screening. The protocol talks about how to create these safe spaces and making sure that you tell the patient that you're going to be asking these kinds of questions and that they feel that they're in a safe space.
That the trafficker is not on the phone with them on FaceTime. That the trafficker has not made their way into the other side of this curtain and is listening in. We talk about how to get these safe spaces. Then the protocol goes through what to do if there is a disclosure and who to call. Here in Chicago, that involves calling the local Chicago Police Department, but also the FBI trafficking agent on call. There is a human trafficking FBI agent stationed here in Chicago who will come and evaluate these cases. We have an elaborate protocol that may not fit every particular hospital, but it's a place to start.
Addressing Suspected & Disclosed Trafficking
When suspecting or after a patient discloses being involved in human trafficking, a clinician's next steps should focus on creating a supportive, non-judgmental environment to build trust. Dr. Julia Geynisman-Tan strongly recommends avoiding expressions of shock or blame, as these can damage the patient-provider relationship. Instead, clinicians should address the patient’s immediate needs, which may range from healthcare concerns like STD testing to basic needs like a shower and a meal. Providers can play a pivotal role in offering a safe space and connecting patients with resources, helping them make informed decisions about their next steps.
[Dr. Amy Park]
As an individual OBGYN or urogynecologist or any person taking care of patients, what steps should we be taking if we suspect that our patient is in this situation of human trafficking?
[Dr. Julia Geynisman-Tan]
I think the first thing is to not act like you are shocked and appalled because that will make it worse.
[Dr. Amy Park]
We got to work on our poker face.
[Dr. Julia Geynisman-Tan]
Yes, you kind of do.
[Dr. Mark Hoffman] Don't shame them. Don't scold them.
[Dr. Julia Geynisman-Tan]
This would not be a moment to be like, "Oh, my God, how did that happen to you?"
[Dr. Mark Hoffman]
No, but truthfully though, I have a lot of patients who've got pain or all sorts of diagnoses who say they can't talk to their doctors about certain things because they've been shamed about certain behaviors. It's just the judgment from clinicians, sadly, it's not an uncommon thing. This is for all sorts of things that, are, again, I don't want to use the word normal because I don't want to impress upon anyone my version of what I perceive to be normal or abnormal. These women say, "I was told this is my fault." It's unbelievable what patients will tell me that they're been told by the providers.
[Dr. Julia Geynisman-Tan]
Yes, absolutely. I think that you'd be surprised what patients hear us saying outside of their exam room also to other nurses, physicians, staff. That even if you have a great poker face when you're in the room with the patient and then you leave and they hear you retelling their story as if it's this crazy salacious thing behind the curtain, that encounter is done. You have lost their trust.
[Dr. Mark Hoffman]
That's a good point. Those walls are thin, those doors are not soundproof. We have to remind teams all the time. Even if you're laughing about something else, someone's just trying to be a pro at work and Amy can vouch for this. I can certainly laugh and have fun, but at work, I'm super boring and very clinical because you don't want people to think we're making light of anything that's going on. No, it's such a good point that I wanted to highlight. I appreciate that because there's just people have in front of the hallway and someone's really shared something really personal and like, "Oh, my God, are they laughing at my story?"
We don't think of it, but that's such a great point you bring up.
[Dr. Julia Geynisman-Tan]
I think once you have heard some disclosure like that, then the next thing really is to say, "What do you need? What things do you need first today?" You might think that what that person needs is immediately a safe space to go to, they need to call the police. We got to get this investigation rolling and rip them out of whatever situation, but that may absolutely not be what they need.
They may say to you, "What I need is to have my pain treated so that I actually have the emotional capacity to figure out what I want to do with my life and with this person who's in my life. I don't need you to do anything for me related to the trafficking. I need you to treat the pain that I came here for. Then I will be able to take care of my situation."
[Dr. Mark Hoffman]
Their medical problem may be part of their dependence on this other person. That's interesting.
[Dr. Julia Geynisman-Tan]
I think figuring out what it is that they need. I will say, I have done a lot of social admissions for patients like this, where they may say, "I don't really even know what I need because I don't know where I've been this last week. I just need some time to think and a safe place and a hot shower and a meal. I want to call my mom." In those cases, I make up all kinds of reasons to admit them to the hospital for their pelvic pain or UTI or whatever it is. Then they sleep in the hospital for a few nights. In two days I have social work come and talk with them and we figure out what it is that they want to do next.
Inevitably this always happens on a Friday. They have a couple of days before all of the shelters open and all of the social work and community partner groups open. Then we figure out where they're going to go.
Podcast Contributors
Dr. Julia Geynisman-Tan
Dr. Julia Geynisman-Tan is an OBGYN at Northwestern in Chicago, Illinois.
Dr. Mark Hoffman
Dr. Mark Hoffman is a minimally invasive gynecologic surgeon at the University of Kentucky.
Dr. Amy Park
Dr. Amy Park is the Section Head of Female Pelvic Medicine & Reconstructive Surgery at the Cleveland Clinic, and a co-host of the BackTable OBGYN Podcast.
Cite This Podcast
BackTable, LLC (Producer). (2024, November 19). Ep. 71 – Human Trafficking: Red Flags & Clinical Guidance [Audio podcast]. Retrieved from https://www.backtable.com
Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.
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