Vital Views

In honor of National Slavery and Human Trafficking Prevention Month, UNLV Nursing doctoral alumnus and chief nursing officer Joe Alvarado shares insight on the red flags of human trafficking and how nurses can intervene in clinical settings to save potential victims.

Creators & Guests

Joseph Gaccione
Host, Writer, Producer
Joe Alvarado
Chief Nursing Officer, Crescent Medical Center, Lancaster, TX

What is Vital Views?

Vital Views is a weekly podcast created by UNLV School of Nursing to discuss health care from a Rebel Nursing perspective. We share stories and expert information on both nursing-specific and broader healthcare topics to bring attention to the health trends and issues that affect us. New episodes every Tuesday.

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Joe Gaccione 0:02
You're listening to Vital Views, podcast for UNLV School of Nursing. I'm Joe Gaccione, communications director for the School of Nursing. January is National Slavery and Human Trafficking Prevention Month. Although a month is not nearly enough to focus on the horrors of human trafficking and its branches, it does provide a bigger focus on this criminal practice. Human trafficking doesn't just cross lines of legality and ethics, but healthcare as well. Nurses and other providers have opportunities to not only spot potential victims, but to save them as well. Joining us today to talk more about anti-human trafficking is UNLV Nursing Alumnus Dr. Joe Alvarado. He graduated in 2021 from the Doctor of Nursing Practice Program here at UNLV. Dr. Alvarado is currently the chief nursing officer at Crescent Medical Center, Lancaster in Texas. As a DNP student, his research was specifically on creating protocols for identifying potential human trafficking victims in emergency department settings, and he's had experience partnering with community leaders in Texas to enhance victim support. Dr. Alvarado, thanks for coming by. So, Dr. Alvarado, what are the most common red flags for human trafficking, especially to a health professional like a nurse?

Joe Alvarado 1:19
So, there are a variety of red flags that can be indicators of trafficking, but we must keep in mind that there really isn't a definitive list per se nor will every person who's being trafficked, you know, in the healthcare setting, present themselves with the same red flags, you know, as others. So, so they can be categorized into three types: physical, behavioral, and environmental. Examples of physical red flags, patients who present with bruising and burns specifically, like maybe from cigarettes. For sex trafficking victims, multiple pregnancies and/or pregnancy terminations and frequent sexually transmitted infections and injuries, but also tattoos and burns and scarring that indicate branding. Branding is another very popular physical red flag. Behaviorally, people who are being trafficked can exhibit an inability to focus and concentrate. They can be unaware of their location, sometimes even their age or timeframe, you know, the date. These victims often exhibit very reserved avoiding type interactions with healthcare providers and they provide very limited information. So, there's also fear of appointments taking too long longer than expected and frequent need to update, perhaps a friend or spouse or some significant other can be a flag. Environmentally, many times people who are being trafficked are accompanied by another person, could be a handler handling that particular victim or the trafficker themselves, who many times will answer questions for the victim, preventing them from speaking freely and, you know, these handlers or, or traffickers will constantly try to accompany this person and will try not to leave them alone as to, you know, give them the opportunity to perhaps provide a signal to the healthcare provider or even clues or further red flags that can help identify them.

Joe Gaccione 3:20
And that leads to my next question about nurse training, healthcare professional training. We mentioned before in your introduction about your doctoral research when you were a student here at UNLV. Can you talk about some of the training, some of the techniques that nurses should have in emergency department scenarios where they need to be able to pick up on these cues?

Joe Alvarado 3:39
Well, sure. So let me, let me kind of back up a little bit more with that question, just explaining that, you know, through advocacy and even legislation that human trafficking awareness has steadily been on the rise over the last 10 years. However, there, there is a gap there that reveals that there isn't, or was not really a standardized education for healthcare providers. Now, there has been some, and there's been more progress in that, that area of standardizing education in the last 10 years, but specifically the training that I evaluated and identified that there, there was this gap especially in the environment that I was working in with knowing the, the, the research also showed that there were trafficking victims that were coming to seek healthcare, especially in ER, you know, settings. 88% of victims per one study sought care in the healthcare environment with 63% actually in the ER setting. So this obviously makes that education very critically important to give healthcare teams so that they're able to help identify potential victims of human trafficking.

Joe Gaccione 4:48
I imagine it has to be difficult to identify red flags and potential treatment for victims because the cases have to be reported. You know, I, I imagine with these stats they have to be a little skewed because these are reported cases, correct?

Joe Alvarado 4:59
Well, not all cases are reported, so definitely certain states have, have mandates that require providers, healthcare providers to, to legally, to report cases for minors. However, given that many times these victims who've been in trafficking situations are now adults and they're coerced into their situations oftentimes even if identified, they wish, they choose not to prosecute or proceed to report themselves. And so you begin to deal with that situation that, you know, you don't want to violate their, their, their privacy, right? When you clearly, they clearly understand they're in a situation that they don't want to be out of yet. Unfortunately, that is the case sometimes and you just have to be able to provide resources and support to that, that current victim and, you know, allowing them to understand that there potentially can be ways for them to have help and support out of their situation.

Joe Gaccione 5:52
It's almost like, and this is not to sound dramatic, although this is a, a dramatic subject, that nurses and other healthcare providers can be that last line of defense for a victim if they come in, let's say with someone else and the other person is doing all the talking, that potential victim will have those signs and the, the nurse has to be able to, for lack of a better word, separate the handler from the victim and say, “We're offering your help, because we think this might be, this might be a, you know, you might be in trouble.”

Joe Alvarado 6:22
Yeah. I mean it's, again, critically important for those caregivers in those, you know, point of care roles to understand those red flags and, and understand that, you know, they know how to identify these potential victims of trafficking. It's also very important that they know how to report, how to approach them and how to care for them, that's critically important, but oftentimes, you know, if, if they don't receive this training, if they, if they're not aware, or if they're in a, a very, very busy overcrowded, let's say, emergency room setting where bed turnover is important and getting to the next patient's important, you know, oftentimes it can very easily get overlooked and those nurses are, and may very well be, the only contact that victim might have for a period of time. They very much are the very last line of defense for potential freedom or rescue for that victim.

Joe Gaccione 7:12
What drove you to study this topic when you were at UNLV and then pursuing it even after you graduated?

Joe Alvarado 7:19
While at UNLV, the project of implementing the protocol for identifying potential victims of trafficking wasn't my first choice as a project. I spent my first semester focused on emergency room overcrowding and optimizing flow. It was a point where I switched jobs and had a different type of work environment, still emergency room care, but more of a, in a freestanding ER setting that I had to kind of pivot pretty quickly and come up with a different project that I could implement because I was no longer working in a very busy overcrowded ER, I was in a freestanding ER, company that owned and operated several freestanding ERs where the volumes are much lower, but it's more of a concierge type of approach to emergency room care. So, I was with really the, the insight and the support from my co-chair for my project, Dr. Paul Clements, who is a forensic psychiatric clinical specialist, and he's amazing. He focuses, his focuses include, you know, mental health care, trauma, grief counseling. It was through discussions with him that really helped me identify that, you know, there is research to do on this topic even in the freestanding ER environment and that was kind of how I was led to dive into the research and identify the gaps, that there is a, a very critical need to educate frontline healthcare providers, especially in the freestanding emergency room setting.

Joe Gaccione 8:44
On this topic, you mentioned advocacy near the beginning of the interview. You've done community outreach before, not just in the hospital setting, but outside I believe through, through a church, correct?

Joe Alvarado 8:53
Yes. So, while I was actually doing the education to my emergency room teams in the freestanding ER facilities, I came across a organization named Restored Hope Ministries, and Restored Hope is a ministry that is here in the Dallas-Fort Worth area, and they're actually a, a brick and mortar building ministry that rescues and actually takes in survivors either out of jail that, you know, people who are put in jail for trafficking situations, women particularly of sex trafficking, and/or off the street, and they rescue and restore, you know, hope back into their lives. And we partnered in my last company and we actually were providing stabilization care, pre-care for those survivors to enter their, their home for treatment and counseling and whatnot. And so, that led to a very great partnership with my former company, and it also continues now in my new role as a chief nursing officer at, at Crescent Regional Hospital here in Lancaster, Texas. I've continued that advocate, advocacy and that support of that, of that ministry, and we actually still use this new hospital where I'm at to provide care and screen, screening and, and whatnot to survivors that they rescue, so we're still in partnership today. Our hospital treats those survivors as a courtesy free of charge to that organization.

Joe Gaccione 10:23
There's something to be said about having a direct impact on your community, I mean as a nurse, as a registered nurse, I mean, it doesn't matter what level of nurse you are, you're going to to have an impact, a positive impact on the people around you, the people that you treat, but it's fascinating to see as you advance your education, you know, from a graduate level, master's level, and then especially the doctoral level, that impact grows significantly to where you're potentially influencing entire populations, not just your local community. What does it mean to you, that significance of your work?

Joe Alvarado 10:57
Well, I can very easily talk about supporting anti-trafficking efforts and advocacy and those, those things about trafficking that really people become so interested in learning about those statistics and, you know, how they can then help support those same efforts. That part is very easy, it's just really showing those, anyone and everyone, that they're capable of supporting those initiatives, whether just through raising awareness or even volunteering for the many number of different organizations that support anti-trafficking efforts, like Restored Hope Ministries, there are many others. So, I share with people that the work I did on this project, getting a doctoral degree, became kind of a, took, took on kind of a life of its own once I began to incorporate Restored Hope Ministries’s assistance in educating my team and really having an actual survivor speak to those red flags that I'm training my team members to notice, you know, that supportive guest, if you will, on our, during our training to actually validate the training and say, “Yes, the, these things do happen.” We do present to EDs, we do have these signs and people just need to pay attention and, you know, you'll identify more of it. That just went such a long way and helped the project really just continue to grow interest and it just, it's helped it continue to, still to this day, support, you know, positive outcomes for this population of particularly female women who are being sex trafficked.

Joe Gaccione 12:31
When we think of human trafficking, we think probably, the first image that comes to mind is women, but I'm sure it's, it's not just women, correct?

Joe Alvarado 12:41
Oh, correct. So, moreover, there's all, you know, there's forms of trafficking that are covered in the education, which include labor trafficking, you know, of course, sex trafficking, organ trafficking as well. And the training, you know, is victim-centered. It's culturally relevant and evidence-based as well as gender gender sensitive and, and of course, trauma informed. So, that's the standardized approach to the training that should be given to every, any healthcare provider, you know? In the country, there's progress being, being made. Currently there are 14, I'm sorry, there are 15 states that actually mandate and regulate human trafficking education as part of, you know, either the healthcare's knowledge of the training that's required annually. Now of the 15 states, I think there's four that actually require and mandate that certain healthcare providers with a license, like nurses, have to do annual or biannual education, CEUs, to actually renew their license. So, there's progress being made throughout the country with that. It could, it should be happening quicker, I believe, but there's definitely more progress that, you know, needs to continue to be made, kind of mandating this standardized education that really every, every healthcare provider should, should know and should have.

Joe Gaccione 13:56
What are some available resources for people out there, whether they might know someone who could potentially be a victim or for a victim? I know you're based in Texas, but are there national resources that you recommend specifically?

Joe Alvarado 14:09
Yes, so there's actually, there's a number of different resources, even by state, that are provided for not just healthcare personnel, but law enforcement and even victims themselves. There's national hotlines, the one that's used most often is 1-(888)-3737-888, and this is, this is a national hotline that receives calls from across the country from different, other organizations, looking to learn more, learn what resources are in their area or even report, you know, incidences of trafficking.

Joe Gaccione 14:45
And we will have those resources on this episode page when it drops. Dr. Alvarado, that's all the time we have. Thank you so much for coming in.

Joe Alvarado 14:51
Oh, well thank you so much for having me. It's such a very important topic. It's, you know, it's my pleasure to share any knowledge or any, any information I have about it and continue to raise awareness. Thank you.