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Human Trafficking: A Treatment Guide for Mental Health Professionals is the first book on human trafficking and mental health. The editors have marshalled their considerable experience developing resources and interventional programs for this patient population, as well as expertise in research and scholarly writing, to create a unique—and uniquely useful—guide for clinicians likely to encounter trafficked patients. Foundational to the effort is recognizing that their numbers are legion, and growing, and that their safety and well-being depends on the ability of clinicians to screen, assess, and identify them in a system that often constructs barriers to care.
Epidemiological data is provided to help clinicians understand the factors that contribute to being trafficked, the associated consequences, and the role of health professionals in combatting it. Screening processes are discussed, and potential barriers, both organizational and provider-based, to the identification of trafficked persons are explored. The next section addresses sensitive, trauma-informed, and integrated patient management in different settings, including emergency departments, primary care, and substance abuse facilities, since both medical and substance abuse comorbidities are common in trafficked patients. The trauma-informed concepts of asking, respecting, and responding are vital components to the survivor-centered care emphasized by the authors, and psychotherapeutic considerations and cultural aspects in the assessment and treatment of these patients—topics that have been neglected heretofore—are discussed in-depth. Finally, advocacy, confidentiality, and reporting requirements for adult and child patients are addressed, providing a much-needed legal and ethical framework.
The chapters have clearly outlined objectives that are
achieved through a number of useful features:
• Each chapter includes clinical cases that encapsulate the trauma and
horror of the real-life fallout from human trafficking. These vignettes
deftly illustrate and contextualize the chapter's topic, such as managing
co-occurring substance use disorders or identifying the trafficked person
who presents in the emergency department.
• Chapters are equipped with
"pearls and pointers" that summarize key points and highlight the most
important take-aways.
• Contributors make ample use of visual aids, such
as tables and figures, that enhance understanding and consolidate
information into readily accessible formats.
• Ten vivid, real-life case
scenarios are offered in the final chapter, providing the clinicians with
insights into trafficked persons' health care interactions, questions to
increase sensitivity and help identify these patients, and counsel on
managing their care with empathy and patience.
Often shocking, frequently poignant, and always useful, Human Trafficking: A Treatment Guide for Mental Health Professionals teaches clinicians to look at their patients with fresh, informed, and compassionate eyes.
The International Labour Organization reported
that, in
2016, 24.9 million people were trafficked,
20.1 million as forced labor
and 4.8 million for
commercial sex. These numbers are probably
an
underestimate but they indicate that human trafficking is a huge
problem that psychiatry has
neglected. The editors of Human Trafficking:
A
Treatment Guide for Mental Health Professionals
have put together
a very experienced group of
authors who provide a rich and
comprehensive
review of this human tragedy. In their preface,
the
editors state that their goal was to create "an
educational and
clinical resource for mental health
practitioners as well as clinicians
from any discipline who might encounter trafficked persons
(which is
essentially all of us in the health care
field)." The 25 authors include
international
experts in multiple disciplines, 14 of whom
are
physicians. Each chapter is concisely written and
includes
diagrams and charts as well as "Pearls
and Pointers" at the end to
emphasize the main
points. As the editors' goal was to create a
reference source, each chapter also includes an extensive
bibliography.
For clinicians, I single out some particularly
helpful
information. There is an excellent
description of signs and symptoms
that may present in a trafficked person in the emergency
department. The
discussion of comorbid medical
conditions covers sexually transmitted
diseases
and the need to coordinate interventions for both
physical
and mental health. Trafficked individuals
face many difficulties
accessing medical care,
including especially being able to pay,
language
barriers, safety concerns, and chronic illnesses
that
require long-term care that is not usually
available to someone who is
trafficked. Special
chapters deal with sexual abuse and child
trafficking for labor and sex. Since many trafficked
persons in the
United States come from foreign
countries, cultural issues and the need
for culturally appropriate assessment is very important and
these topics
are well covered.
When discussing management, all of the
authors
emphasize the need for trauma-informed
care that is characterized by
empathy, trustworthiness, and collaboration; however, this stress
on the
need for "trauma-informed care" may seem
like an overused platitude.
Although there are no
data or evidence to guide treatment, the use
of
cognitive-behavioral or exposure therapies to treat
trafficked
individuals does not seem to be a good
idea. These patients come from
different cultures
and have massive traumas that greatly
impair
their ability to process information. Providing
exposure
therapy to people who suffer from frequent nightmares and startle reactions
seems
almost harmful. For long-term treatment, gentle
consistency
and judicious use of medicine in a
supportive relationship seems likely
to be the
most helpful method for reducing suffering, even
though
firm evidence is lacking.
The last chapter "Survivor Voices"
presents
accounts by those who escaped and were able to
recover and
write about their traumatic experiences. These are truly inspiring stories
by remarkable people who have triumphed. However, I
wonder about the
hundreds of others who were not
able to escape, who live out a life of
humiliation,
fear, drug addiction, and struggles with depression
and
suicidal thoughts.
In summary, this is an excellent book about
a
neglected and underreported group. People who are
trafficked have
multiple psychiatric and other health
disorders and clearly need medical
approaches to
alleviate their suffering.
— J. David Kinzie, MD
John Coverdale, M.D., M.Ed., is professor of psychiatry and medical ethics at Baylor College of Medicine in Houston, Texas; serves as deputy editor of Academic Psychiatry and associate editor of Academic Medicine ; and co-directs the anti-human trafficking program at Baylor College of Medicine.
Mollie R. Gordon, M.D., is an associate professor in the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine in Houston, Texas, where she is a co-director of the Anti-Human Trafficking Program. She is a co-chair of the American Medical Women's Association Physicians Against the Trafficking of Humans, is on the HEAL trafficking speakers bureau, and has opined for the Office of Trafficking in Persons.
Phuong T. Nguyen, Ph.D., is an associate professor in the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine. He is director of psychology services at Ben Taub Hospital and the program director of the BCM Anti-Human Trafficking Program. Additionally, he serves as the training director for the BCM Psychology Internship Program and the Ben Taub Hospital/BCM Psychology Postdoctoral Fellowship Program, which includes the country's first formal psychology postdoctoral fellowship track specializing in anti-human trafficking work.
Chapter 1. Becoming a Trafficked Person
Chapter 2.
Epidemiology of Human Trafficking: The Complexities and Intersections of
Vulnerability, Risk, and Exploitation
Chapter 3. By the Right Name: What
Does It Actually Mean to "Screen" and "Assess" for Trafficking in Health
Care?
Chapter 4. Barriers to Identification of Trafficked Persons in
Health Care Settings
Chapter 5. Emergency Department Management of
Trafficked Persons
Chapter 6. Managing Trafficked Persons With Comorbid
Medical Conditions
Chapter 7. General Principles of Care for Trafficked
Persons
Chapter 8. Responding to Trafficked Persons in Heath Care
Settings: Patient-Centered, Survivor-Centered Care
Chapter 9. Care
Management of Trafficked Persons With Substance Use Disorders
Chapter
10. General and Specific Psychotherapy Considerations for Managing
Trafficked Adults
Chapter 11. Child Sex and Labor
Trafficking
Chapter 12. Cultural Aspects in the Assessment and
Management of Trafficked Persons
Chapter 13. The Clinician as Advocate:
Confidentiality and Reporting Requirements
Chapter 14. Survivor Voices:
Case Scenarios of Labor and Sex Trafficking