Newly Released Core Competencies: An Essential Component to Health Systems’ Human Trafficking Response

1 December 2021
Policy Innovation

Preeti Panda  | Pediatric Emergency Medicine, Stanford University
Cathy L. Miller  | Professor of Nursing, University of Texas Tyler
Jordan Greenbaum  | Medical Director, International Centre for Missing and Exploited Children
Hanni Stoklosa  | Executive Director of HEAL Trafficking

The majority of trafficked persons access health care while being trafficked. Health practitioners globally thus need to be poised to respond to trafficked persons they encounter.

The U.S. Department of Health and Human Services Office on Trafficking in Persons (OTIP) in partnership with the SOAR Coordinating Group, HEAL Trafficking, the National Association of Pediatric Nurse Practitioners and the International Centre for Missing and Exploited Children have created a set of Core Competencies for Human Trafficking Response in Health Care and Behavioral Health Systems.

The purpose of these competencies is to outline target areas and proficiencies required to comprehensively identify and respond to both trafficked and at-risk individuals. The report defines core competency as the “skills needed for professionals to conduct their work most effectively.” The outlined competencies provide trauma-informed (TI), survivor-informed (TI) and evidence-based (EB) guidance to improve the health-care response to human trafficking. The guidance is geared towards stakeholders at the level of the health-care professional, health-care system, academic institution, as well as health care training programs.

Because the competencies are targeted towards both organizations and stakeholders within health systems, they can be universally applied to any health care or behavioural health setting. Each competency outlines relevant sub-competencies specific to the domains of the individual provider, organization/institution, researcher and/or educator. Thereby, empowering stakeholders at all levels of a health or behavioral health institution with competencies to inform their response to human trafficking (HT).

Notable Outcomes

The process of the development of the core competencies resulted in one overarching universal competency — a trauma-informed, survivor-informed and culturally responsive approach — as well as six core competencies: 1) Nature and epidemiology; 2) Risk; 3) Needs evaluation; 4) Patient-centered care; 5) Legal/ethical standards; 6) Prevention (Figure 1). The competencies include evidence-based (EB) recommendations that may be incorporated into existing health system frameworks at multiple levels. Notable recommendations from the report include integrating trauma- and survivor-informed principles, shifting the focus away from disclosure, inclusion of at-risk individuals and delineating the role of multi-level prevention and response. 

Focus on trauma-informed care and survivor-informed initiatives

While previous recommendations for serving survivors of HT have emphasized utilizing trauma-informed care (TIC), identifying TIC as an umbrella universal competency helps to solidify the importance of integrating TIC principles in every component of the HT response. Translating theoretical concepts of TIC into tangible and measurable interventions empowers organizations and stakeholders with EB guidelines, tools and frameworks to optimize the delivery of care to individuals who have experienced trafficking.

There is also a growing body of evidence that any initiatives in response to HT should be survivor-informed. Centering the voices of those with lived experiences, forming equal partnerships and compensating experts for their time and expertise are key components to a responsible and effective programme. The report’s inclusion of these concepts as guiding principles is fundamental to ensuring initiatives are survivor-informed.

Shift away from disclosure

A key paradigm shift the competencies provide is moving away from an emphasis on an individual’s disclosure of HT: “…disclosure is not the goal; rather, the primary goal is to provide excellent care to all patients” (pg 19). This approach is a direct application of TIC, prioritizing the needs of the patient and acknowledging their unique situation. Focusing on what is best for the patient at the time, rather than a disclosure of the trafficking situation, acknowledges the effects trauma has on survivors and respects their autonomy.

Increased emphasis on the at-risk population

The report advocates prioritizing screening for risk of trafficking in addition to screening for confirmed trafficking cases. Similar to the de-emphasis on disclosure, including patients at high risk of trafficking in EB screening practices allows providers to identify a wider subset of patients that would benefit from resources and connection to services that may otherwise only be offered to those who are confirmed to be trafficked. Identifying and understanding the at-risk population also serve as a foundation for the development of effective prevention initiatives.

Multi-level Prevention

Competency 6 is focused on prevention. When framing human trafficking as a public health issue, prevention is essential to address exploitation from a public health, upstream perspective. As prevention has been cited as an important research priority, this competency serves as a guide for designing and implementing such programmes. The report defines primary, secondary and tertiary prevention, and provides tangible steps stakeholders can take at each tier of prevention.

Policy Implications

The core competencies have various important global health policy implications with regards to individual practitioners, institutions and national health systems. Health practitioners, researchers and educators conducting independent projects on and seeking to provide direct services to trafficked persons would greatly benefit from consulting the core competencies to inform their work. The competencies also align with existing educational and policy frameworks. Notably, this includes the Delta 8.7 Justice Policy Guide, which evaluates evidence underlying the efficacy of health-care interventions for TIP. Using the core competencies in conjunction with existing frameworks will strengthen programmes and allow leadership to ensure they have not overlooked important aspects to develop a comprehensive initiative that can serve trafficked individuals.

Institutions should be encouraged to use the competencies as a guide for their organization’s response to TIP. Consulting the core competencies, in conjunction with existing guidance for creating protocols, can provide a starting point to lay the foundation for holistic organizational programmes to serve trafficked persons. Additionally, existing programmes can be reviewed through the lens of the principals outlined in the core competencies and evaluated accordingly for areas of improvement.

Finally, the core competencies have significant national and international implications for governing health-care bodies. An increasing number of health ministries are beginning to focus on the health-care sector’s role in addressing, preventing and caring for trafficked persons. Adoption of the core competencies by ministries of health worldwide would provide a step towards a more systematic, public health approach to human trafficking. Inclusion of the principles outlined in the competencies by national health organizations would likely improve impact on the health and well-being of survivors because they shed light on the health sector’s role in anti-trafficking response.

Figure 1. Core Competencies For Human Trafficking Response in Health Care and Behavioural Health Systems

Image source: National Human Trafficking Training and Technical Assistance Center. (2021). Core Competencies For Human Trafficking Response in Health Care and Behavioral Health Systems, Infographic. https://nhttac.acf.hhs.gov/sites/default/files/2021-02/Core%20Competencies%20Infographic.pdf

This article has been prepared by Preeti Panda, Cathy Miller, Jordan Greenbaum and Hanni Stoklosa as a contribution to Delta 8.7. As provided for in the Terms and Conditions of Use of Delta 8.7, the opinions expressed in this article are those of the authors and do not necessarily reflect those of UNU or its partners.

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