Training nursing students to identify and respond to human trafficking
New curriculum resources can help ensure that nursing students are equipped to recognize human trafficking
In hospitals and clinics throughout the United States, healthcare professionals miss the signs and symptoms of human trafficking every day. Without recognition and intervention, the second largest criminal industry in the world continues to thrive, ensnaring 50 million people and generating $346.7 billion annually (Hope for Justice, n.d.; Nasdaq & Verafin, 2024).
“No demographic is spared. These victims can be female and male, child or adult,” said Francine Bono-Neri, PhD, RN, APRN, PNP, cofounder and president of Nurses United Against Human Trafficking (NUAHT). “Human trafficking is psychological manipulation that is difficult to recognize, which is why it’s so important for healthcare providers to receive training.”
Human trafficking takes many forms and can be overlooked in healthcare settings
Human trafficking is the exploitation of people through forced activities and manipulation of emotions, finances and living conditions. Types of human trafficking include:
- labor trafficking
- sex trafficking
- child trafficking
- familial sex trafficking
- bonded labor
- forced marriage
- organ trafficking.
A majority of trafficking victims receive healthcare services while being trafficked, yet their abuse is not recognized because nurses, emergency responders, and others in the healthcare setting don’t recognize the signs of this manipulative crime. Only 10 states mandate that healthcare professionals complete continuing education on human trafficking, leaving thousands of healthcare workers in the dark about its health impacts and the signals leading to identification.
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Dr. Bono-Neri, an educator and clinician who has practiced as a nurse practitioner and nurse in multiple settings, is among the thousands of providers who received no information about human trafficking for many years. She was alerted to it when she heard a presentation by Tammy Toney-Butler, RN, CEN, TCRN, CPEN, a former emergency department nurse who is a survivor of sex trafficking.
During Toney-Butler’s session, Dr. Bono-Neri had a vivid memory of a young woman she had assessed the year prior — a 16-year-old female with multiple skin eruptions, lice, malnourishment, IV drug marks, a urinary tract infection, and scattered communication who was accompanied by a well-dressed older man.
This adolescent was being trafficked. And she had missed it. “It was a devastating realization,” she said. “I failed as a mandated reporter.”
Dr. Bono-Neri shared her experience with Toney-Butler that day and expressed a desire to take action — immediately. The two partnered to establish NUAHT in 2020, and the organization now provides education modules, protocols, and other resources to help healthcare professionals recognize and combat human trafficking.
As part of NUAHT’s work, Dr. Bono-Neri and Toney-Butler developed a progressive six-module course that can be aligned with a nursing curriculum or provided as standalone education, much like American Heart Association training for pediatric and adult life support.
Dr. Bono-Neri and Toney-Butler prioritized the development of this education program after their study of prelicensure curricula for RNs determined that human trafficking content is taught at a “minimal to zero amount” (Bono-Neri et al, 2023).
Their conclusion? An entire front line of professionals who could identify trafficking didn’t have the key weaponry: knowledge.
“Nurses are ideally situated to identify, treat, and empower victims of human trafficking,” Dr. Bono-Neri said. “There are so many types of trafficking, so many types of victims, and so many type of types of traffickers that unless nurses have a robust foundation for this education, they're going to continue missing these victims.”
Learning how to recognize and respond to human trafficking: A comprehensive curriculum
The asynchronous online training program from NUAHT uses videos, knowledge checkpoints and assessments to gauge learner progress. It is accredited by the American Nurses Credentialing Center, the Accreditation Council for Continuing Medical Education, and the American Society of Radiologic Technologists for 9.0 contact hours or CME credits.
Nursing programs commonly opt for an institutional membership to provide their students and faculty with access to the learning modules, Dr. Bono-Neri said. Institutional memberships can be customized for a program or education setting. Find an overview of membership options here.
The NUAHT training equips learners with the knowledge required to recognize human trafficking and to respond appropriately. The course teaches and demonstrates how healthcare providers can assess a trafficking victim and respond in ways that keep the patient safe, including the notification of law enforcement. The resources include screening tools, downloadable “shoe cards” for victims, and algorithms to guide decision making and management.
The course is organized as follows:
- Human Trafficking 101: History, statistics, situations that place people at risk for trafficking (43 minutes). Potential placement: Growth and development course
- Human Trafficking 102: Head-to-toe forensic assessment, screening questions, mandatory reporting requirements (125 minutes). Potential placement: Fundamentals or health assessment course
- Human Trafficking 103: Adverse childhood experiences and vulnerabilities including opioid use (56 minutes). Potential placement: Community health or maternal health course
- Human Trafficking 104: Neurobiology of trauma and sextortion; mitigating revictimization (53 minutes). Potential placement: Mental health or psychiatric nursing course
- Case studies (6 case studies averaging 45 minutes each). Potential placement: Pair each study with a relevant course (e.g., Case study 1 involves child maltreatment and could be paired with a pediatric health course)
- Targeted healthcare response for identifying and treating a potential victim of human trafficking (30 minutes); provides algorithms and decision trees to assist nurses in decision making about care.
National, state and local support for NUAHT training is growing
To increase awareness of the need for human trafficking education, Dr. Bono-Neri speaks at conferences for healthcare professionals and advocates for human trafficking education in various ways. She presented her research on curriculum deficits in human trafficking at the 2024 Nurse Educator Summit presented by ATI, where attendees buzzed enthusiastically about her passion and knowledge. Soon after that event, she received the 2024 Inspiring Global Nurse Award from Nurses With Global Impact and the 2024 International Ceca Award from the Ceca Foundation. Both awards honored her advocacy on behalf of human trafficking victims and her commitment to equipping nurses to recognize it.
As she and Toney-Butler raise greater awareness about the need for human trafficking training for healthcare professionals, a growing number of agencies and states are committing to this education. The Indian Health Service now provides NUAHT training to its healthcare teams, and the Texas Department of Health and Human Services now recognizes the NUAHT training as an approved human trafficking course for healthcare professionals that satisfies the state’s continuing education requirement for anti-trafficking training at the time credential renewal.
Dr. Bono-Neri urges nurse educators and nursing programs to seize the opportunity to taking definitive steps toward improving the fates of millions of trafficking victims.
“We have students in our four walls of academia for a short period of time, so we can harness this opportunity to make sure that before they graduate, we have educated, equipped, and empowered them with this content,” she said.
“Because once they're out, it falls on state mandates, and the states that require anti-trafficking training as a professional development topic are few and far between,” she continued. “It’s time for nurse educators to bridge this education gap and arm our future colleagues with this vital content so that this population goes invisible no longer.”
Learn more about the NUAHT learning modules here.
To report a case of suspected human trafficking, call the National Human Trafficking Hotline at 888-373-7888. Website: https://humantraffickinghotline.org
References
Bono-Neri, F., Toney-Butler, T. J. (2023). Nursing students’ knowledge of and exposure to human trafficking content in undergraduate curricula. Nurse Education Today. 129, 105920. doi: 10.1016/j.nedt.2023.105920
Hope for Justice. What is human trafficking? https://hopeforjustice.org/human-trafficking/
Nasdaq & Verafin. (2024). Global Financial Crime Report: Insights at the Intersection of Financial Crime Data & Real Survivor Stories. https://www.nasdaq.com/global-financial-crime-report