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Papke K, Ashcraft A, Auger J, Carmona Caravelli A, Liu S, Riley E, Paulsen J, Chamberlain J. The Impact of Human Trafficking on Veterans: Increasing Awareness Among Veterans and Employees through Education. HPHR. 2021;58. 10.54111/0001/FFF3
Health care systems serve an essential role in identifying and treating individuals impacted by human trafficking. The Department of Veterans Affairs (VA) Veterans Health Administration recognizes that human trafficking is a public safety concern and has intentionally increased awareness of human trafficking and how it relates to Veteran care. In 2020, the VA National Social Work Program Office, Care Management and Social Work launched a national Human Trafficking Tiger Team to understand the impact of human trafficking within the Veteran community.
Initial Human Trafficking Tiger Team efforts focused on qualitative reviews of existing VA health care services data to identify trends and themes. A series of three trainings for VA staff including Social Workers, Licensed Marriage and Family Therapists (LMFT), Licensed Professional Counselors (LPC), Psychologists (PsyD/PhD), Registered Nurses (RN), and Certified Rehabilitation Counselors (CRC) were completed. A pre and post-test was administered to assess VA staff’s knowledge about human trafficking and the impact on the Veteran community.
Upon examination of qualitative review of evidence, formal study is needed to develop programming to address human trafficking in the Veteran community.
Further study is needed to understand the prevalence of human trafficking among the Veteran population. While the VA’s human trafficking initiatives are integral initial steps, additional research remains necessary to identify treatment needs and services gaps.
Human Trafficking Tiger Team Knowledge Needs Assessment trainings revealed that VA staff had contact with survivors of human trafficking, suspected victims, as well as traffickers. 38% of staff acknowledged missed opportunities to assess and intervene with potential trafficking victims. This revealed a clear need for standardized screening, protocols, and implementing routine training to Veterans impacted by human trafficking.
Human trafficking is a public health concern that impacts people of all ages, races, genders, nationalities, and sexualities.1 Specific individuals may be more vulnerable to exploitation due to the impact of socio-economic circumstances, physical, and mental health factors. Veterans may be at an even greater risk of being trafficked than the general population due to an associated high prevalence of known risk factors such as homelessness, substance use, suicidality, potential history of witnessing violence, intimate partner violence, sexual assault, and the lack of other social determinants of health.2 Identifying and providing care for a trafficked individual can be challenging. Understanding the impact and prevalence of human trafficking among Veterans, their families, and caregivers helps identify gaps in service needs within the Department of Veteran Affairs (VA). Gaining trust and building rapport among the Veteran population and those who have experienced trafficking is imperative.
VA is a dynamic partnership with a shared mission across three organizations. The Veterans Health Administration (VHA) manages one of the largest healthcare systems in the world. The Veteran Benefits Administration (VBA) supplies compensation and vocational assistance to disabled Veterans. The National Cemetery Administration (NCA) honors Veterans with a final resting place and lasting memorials that commemorate their service to our Nation.
The VHA is the most extensive integrated health care system in the U.S. and provides care at 1,293 health care facilities, including 171 medical facilities and 1,112 outpatient sites. Each year, 9 million Veterans seek treatment or are enrolled within the VA Healthcare System. Additionally, there are VA medical facilities in all 50 states, including the District of Columbia and several US territories, including American Samoa, Guam, Puerto Rico, and the Virgin Islands.
VA’s National Social Work Program Office, Care Management and Social Work launched a national Human Trafficking Tiger Team to review and better understand the potential impact of human trafficking within the Veteran community. The goal of the Human Trafficking Tiger Team was to establish an initiative within the VA healthcare system by educating and promoting an understanding in identifying, intervening, and supporting Veterans, their families, and caregivers impacted by human trafficking.
A tiger team is a specialized, cross-functional team brought together to solve or investigate a specific problem or charge. The term “Tiger Team” originates from the military. It was made famous by National Aeronautics and Space Administration (NASA) who deployed a tiger team during the Apollo 13 mission in 1970. Tiger teams are a popular and effective team structure for organizations who need a focused group of experts to manage technical deployments and solve complex issues.
The Human Trafficking Tiger Team consisted of 35 experienced VA human trafficking subject matter experts across the nation. The Team came together with the intention of gathering evidence-based materials to establish training slides, fact sheets and other educational materials. Through this literature and research review, the high-risk factors associated with human trafficking directly correlate to common risk factors among the Veteran population. One commonality to all forms of human trafficking is the impact of trauma and violence on the victim’s physical and emotional health. If a victim’s health makes them unable to work, a trafficker may allow the victim to obtain minimally necessary medical care. According to the American Public Health Association,4 87.8% of human trafficking survivors had contacted a healthcare provider in some capacity during their victimization. Additionally, 63.3% were seen by a medical provider in an emergency room setting while being trafficked. Medical providers are a unique point of access to help victims while being trafficked. The VA is uniquely poised across the nation to identify and address potential trafficking victims.
In 2014, the VA National Intimate Partner Violence Assistance Program (IPVAP) was established as a grassroots program to bring awareness to intimate partner violence (IPV) and promote healthy relationships for Veterans, their partners, and VA staff. Research has identified that intimate partner violence and domestic violence is considered a high-risk factor for human trafficking. Further research has indicated that those experiencing violence and those using violence can be at an elevated risk for human trafficking.5 In addition, those experiencing violence within their relationship or home have increased vulnerabilities to social determinants of health, mental health concerns, homelessness, and poverty.2
Intimate partner trafficking can occur when the trafficker convinces their partner to participate in commercial sex acts, forced labor, or other servitude to exert further power and control.6 Partners who traffick may use physical or emotional tactics without ever hitting their partner. The legal documentation needed to escape, such as a passport, driver’s license, or VA benefits card, is often hidden from the partner experiencing violence, leaving them feeling trapped and unable to escape safely. Hiding of crucial documents is a tactic often seen in both IPV and human trafficking cases.
As previously stated, the healthcare setting is perfectly poised to identify and address those experiencing trafficking. Guidance for healthcare providers indicated that two actions need to identify potential patients experiencing IPV and human trafficking effectively. First, all people who experience violence should be addressed in hospital policies, protocols, or standard operating procedures. Second, that staff (clinicians, providers, unit clerks, housekeeping, etc.) are appropriately trained to recognize those who may experience violence. Options to assist in proper education include the development of a decision tree to share with staff for a better understanding of their role when faced with a patient potentially experiencing violence.7
Data from the National Human Trafficking Hotline and the Counter-Trafficking Data Collaborative were reviewed. These sources provide the most extensive data sets on human trafficking in the United States. While this information is comprehensive and readily available, the data does not define the totality of the prevalence and impact of human trafficking. Furthermore, these sources do not collect information on the Veteran status. The authors conducted an extensive literature review and found research related to the impacts of human trafficking among Veterans to be non-existent. Thus, it is difficult to infer how many Veterans are impacted by human trafficking.
The Human Trafficking Tiger Team reviewed internal VA hotline calls, assessment data, qualitative statements and developed a VHA staff knowledge needs assessment. The evidence supports the need to further create a pilot initiative to understand the impact of human trafficking among Veterans.
The Human Trafficking Tiger Team collected and analyzed data from different sources to understand the prevalence of human trafficking within Veteran populations in the United States. These sources include the National Domestic Violence Hotline (NDVH), VA Homeless Operations Management Evaluation System (HOMES) assessment, and the Veterans Crisis Line (VCL). These sources provide limited visibility on instances of human trafficking among the Veteran population. However, using keywords or phrases, the Team was able to identify callers who maybe potential victims of trafficking. This allowed for a broad overview and understanding that Veterans may be experiencing trafficking or are aware of potential trafficking incidents. Using this data, along with the National Human Trafficking Hotline “Ranking of the 100 Most Populous US Cities”8 as well as the aggregate of our Team’s literature review, we identified 10 VA facilities for staff participation in a Knowledge Needs Assessment training.
Participants were asked to identify their VA facility, program office, and discipline in a pre and post-test. The target audience included Social Workers, Licensed Marriage and Family Therapists (LMFT), Licensed Professional Counselors (LPC), Psychologists (PsyD/PhD), Registered Nurses (RN), and Certified Rehabilitation Counselors (CRC).
The pre-test assessed for VA’s staff knowledge on existing human trafficking training and being comfortable with identifying Veterans who experienced human trafficking. The pre-test asked participants if they had ever encountered a Veteran, caregiver, partner/spouse, or family member they suspected was a victim or self-disclosed if they experienced human trafficking. Staff provided examples of those who had encountered a Veteran who had been suspected of, arrested for, charged with, or convicted of a crime related to human trafficking. The post-test inquired about the increase in knowledge for identifying and constructing an appropriate response to Veterans who have experienced human trafficking. It inquired if staff could recall encountering a Veteran who was suspected of experiencing human trafficking. The post-test queried about any missed opportunities to further assess if a Veteran was being trafficked. The test concluded with the ability for staff to be able to list three resources for Veterans, their families, or caregivers that are impacted by human trafficking.8
The VA Human Trafficking Tiger Team has identified Veterans who have experienced human trafficking at VA facilities. A pre and post-test was administered during the Knowledge Needs Assessment training. 651 participants completed the pre-test, and 570 completed the post-test at 10 VA medical facilities. The pre-test results indicated 22% (137/651) of staff encountered a Veteran experiencing human trafficking. Ten percent (66/651) of staff had Veterans self-disclose a situation in which a caregiver, partner/spouse, or a family member experienced human trafficking.
Upon completion of the training, post-test resulted in 98% (560/570) reported an increase in knowledge for identifying and constructing an appropriate response to Veterans who have experienced human trafficking. Thirty-six percent (198/570) of staff recalled encountering a Veteran they suspected was experiencing human trafficking. Thirty-eight percent (213/570) of staff identified a missed opportunity to assess further if a Veteran was being trafficked.
Healthcare institutions can play a vital role in identifying, intervening, and providing treatment and resources for victims of human trafficking. Further study is needed to understand the prevalence of human trafficking among the Veteran population. While the VA’s human trafficking initiatives are integral initial steps, additional research remains necessary to identify treatment needs and services gaps.
Trauma-informed care training for all VA staff is essential to enhancing Veteran care, for general awareness and specialized identification when a Veteran, family member, or caregiver is impacted by human trafficking. VA can further improve Veteran care through the development and establishment of a network of community partner resources for Veterans, their families, and caregivers. VA’s potential reach includes inpatient, outpatient, and telehealth settings as opportunities for intervention and various crisis hotlines, which are often the first touchpoint for impacted Veterans. VA facilities are critical access points for victims of human trafficking due to being the largest integrated health care system in the United States of America.
VA embraces the critical role they play in national efforts to address human trafficking. The Human Trafficking Tiger Team Knowledge Needs Assessment trainings revealed that VA staff had contact with survivors of human trafficking, suspected victims, as well as traffickers. Thirty-six percent of staff recalling encountering a Veteran they suspected was experiencing human trafficking. Thirty-eight percent of staff identified a missed opportunity to assess further if a Veteran was being trafficked. Ninety-eight percent of staff reported an increase in knowledge for identifying and constructing an appropriate response to Veterans who have experienced human trafficking. These results revealed a clear need for standardized screening, protocols, and implementing routine training to support victims and survivors of human trafficking.
While the Human Trafficking Tiger Team’s efforts and recommendations represent an essential first step, further research on the impact of human trafficking on Veterans remains necessary to identify treatment needs and services gaps. Implementing research findings and assessing their effectiveness will be critical to ensure the health and wellness of Veterans.
Katie Papke is a Licensed Master Social Worker, Certified Advanced Alcohol and Drug Counselor, and a Clinically Certified Human Trafficking Victims Services Provider. She is a VA National Social Work Program Project Coordinator and Chair of the Human Trafficking Tiger Team. She is a Social Work Program Adjunct Professor at Grand Valley State University in Grand Rapids, Michigan. Katie has her own private practice and has a passion working with victims and survivors of those who have experienced human trafficking, sexual assault, and trauma. Katie obtained her Bachelor of Social Work and Master of Social from Florida State University.
Amy Aschraft is the Intimate Partner Violence Assistance Program National Program Coordinator and Co-Chair of the Human Trafficking Tiger team. She also currently serves as an adjunct professor at the University of Arkansas Little Rock. She received her formal training at Harding University, University of Arkansas Little Rock and is currently pursuing her PhD. in Social Work at Walden University. Her research is focused on Human Trafficking awareness and prevention.
Jennifer Auger is a Licensed Clinical Social Worker and Board Certified Diplomate in Colorado, with over 10 years of experience in behavioral healthcare. She joined the Veterans Health Administration in July 2019, as a Patient Aligned Care Team Social Worker for the Eastern Colorado VA. In January 2021, Jennifer accepted a position as General Caregiver Support Program Coordinator with the Caregiver Support Program. Prior to Jennifer’s work with the Human Trafficking Tiger Team, she participated in an independent research project designed to facilitate the development of a screening tool to identify victims of human trafficking in healthcare settings.
Anita Carmona Caravelli is a Licensed Clinical Social Worker at the Edward Hines Jr. VA Hospital in Hines, IL. She has worked for the last nine and a half years in Suicide Prevention providing services to the Veteran population. She received an undergraduate degree in Psychology and a Master of Social Work degree from the University of Illinois at Urbana-Champaign.
Jessica Chamberlain is a Licensed Clinical Social Worker at the VA San Diego Healthcare System in San Diego, CA. She has worked for the VA for 23 years and has been in her current role as Chief, Social Work Service for nine years. She received an undergraduate degree in Psychology from the University of California, San Diego and a Master of Social Work degree from San Diego state University.
Shawn Liu is a Community Engagement Coordinator with the Department of Veterans Affairs, Veterans Health Administration, Homeless Programs Office. His research areas include veteran homelessness and suicide prevention. He holds a Bachelor of Arts in Psychology degree from Florida International University, a Master of Social Work degree from Florida State University and is a Licensed Clinical Social Worker with the State of Florida.
Jodi Paulsen is a Housing and Urban Development- VA Supportive Housing Social Worker at the Minneapolis VA Medical Center. She has previous experience working with teenage sex offenders as a sexuality and family therapist. Jodi obtained her Masters of Social and Bachelors of Social Work from the University of Utah.
Dr. Emma Riley is the Intimate Partner Violence Assistance Program Coordinator for VA Boston Healthcare System. Her research areas include abuse, violence, child protection and complex trauma. Dr. Riley graduated with her Doctorate in Social Work with a concentration in Criminal Justice from Walden University in 2019 and her dissertation evaluated the impact of substance use on engagement with survivors of Commercial Sexual Exploitation.
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