Identifying and aiding victims of human trafficking
Human trafficking comes with many misconceptions, including that it's not a problem in Wisconsin and that when it does happen, the victims aren't local.
Both of those aren't true. In 2015, Milwaukee tied Las Vegas for the highest number of victims uncovered in a nationwide human trafficking sting. The city is considered a hub of human trafficking, particularly sex trafficking – and many of those victims are from the north side of Milwaukee.
Angela L. Rabbitt, DO, FAAP, assistant professor of pediatrics at the Medical College of Wisconsin and child abuse pediatrician at Children's Hospital of Wisconsin, has made it her life's work to improve the identification and care of human trafficking victims – in Milwaukee and across the country.
Since 2008, several changes to state and federal law have allowed stronger protections for victims of human trafficking. Around five years ago, MCW started to get more calls from providers and law enforcement officials about potential trafficking victims.
"At that point, human trafficking wasn't something that was on our radar," Dr. Rabbitt says. About a year later, she attended a Department of Justice conference about human trafficking. What she learned gave her a startling realization.
"I thought about patients I had seen and realized I was probably missing this a lot" she says. That realization set Dr. Rabbitt on the path to create care guidelines for victims and an interactive module to train providers on signs that point to potential victims in their clinic.
Doctors are in a unique position to be able to identify and ultimately help human trafficking victims. According to a 2014 study of sex trafficking survivors published in the Annals of Internal Medicine, up to 88 percent were seen by health care providers during their victimization. But medical providers have to know what to look for.
Dr. Rabbitt has partnered with Wendi Ehrman, MD, assistant professor of pediatrics in the division of adolescent medicine, on Proactive Outreach for the Health of Sexually Exploited Youth (POHSEY), a project funded by the Healthier Wisconsin Partnership Program that works to improve sex trafficking awareness and education among medical providers throughout the state. Claudine O’Leary with Rethink Resources and Steve Gilbertson with Wraparound Milwaukee are also partners on this project.
In order to start better educating health care providers about how to care for trafficking victims, Dr. Rabbitt first conducted a needs assessment; for that, she enlisted the help of medical students Megan Lineer and Megan Beck as well as Marlene Melzer-Lange, MD, professor of pediatrics in the pediatric emergency medicine section, and the MCW Division of Quantitative Health Science's Pippa Simpson, PhD, professor of pediatrics, and Melodee Nugent, MA, biostatistician. They found that 90 percent of providers were not confident in their ability to provide appropriate care. They also learned that the preferred format of educational materials was an online module.
Out of that, Dr. Rabbitt and MCW medical student Sydney Hansen created the Medical Response to Sex Trafficking in Minors Training Module in a joint project with MCW, POHSEY, Children's and the DOJ.
"The software allows for interactive quizzing and avatars you can interact with," Dr. Rabbitt says. "It's more interesting than just listening to a webinar."
And preliminary research shows providers are engaged and learning with the tool. Dr. Rabbitt is currently doing an assessment of the module and has found that it significantly increases knowledge.
Dr. Rabbitt also worked on updating guidelines for health care providers treating trafficking victims. The guidelines were developed with a community-based approach and a multidisciplinary committee to make sure that all agencies that interact with potential victims were able to weigh in. The guidelines were published in WMJ, the Wisconsin Medical Society journal, in 2015 and are available to health care providers on the Children's intranet.
Also emerging from the work around the guidelines was the need for better communication and coordination between agencies. This year, a new sex trafficking coordinator position was added to the Milwaukee Child Advocacy Center. This position helps coordinate multidisciplinary meetings between agencies.
And it's been successful. Law enforcement investigators with the trafficking task force report the new initiative has helped improve investigations within Milwaukee.
Now that more health care providers are more knowledgeable about what to look for, there has been an increase in reported cases of trafficking. Between 2010 and 2012, a review of Milwaukee police records found 77 young people identified as trafficking victims. But the real number is likely much higher, says Dr. Rabbitt. According to data collected by Dr. Ehrman and POHSEY, in 2014 alone a review of records at high-risk clinics around Milwaukee found 143 cases of likely human trafficking. In previous years, they found just one or two cases.
Dr. Rabbitt says that MCW has been extremely supportive and the support of medical students who have a passion for addressing social issues has been fantastic. "MCW's mission to promote not only the medical part of health but also the social dimensions of health allows us to do this work," she says.