Hearing the Voices of Human Trafficking Victims

00:00:00:25 - 00:00:38:10
Tom Haederle
For health care professionals, victims of human trafficking aren't necessarily easy to spot. It takes a trained eye, and many victims are reluctant to share much about the horror they endured. Mercy Medical Center in Baltimore, Maryland, has tackled this problem head on with encouraging results. Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications.

00:00:38:12 - 00:01:05:06
Tom Haederle
Five years ago, Mercy Medical Center became part of a local collaborative dedicated to identifying and treating victims of human trafficking. Since then, Mercy has adopted what it calls its Blue Dot program, which flags potential victims of human trafficking for its team of more than 30 forensic nurses who serve the greater Baltimore region. The collaborative has added many partners and reached more than 500 victims of human trafficking over the past five years.

00:01:05:09 - 00:01:22:27
Tom Haederle
In this podcast, hosted by The AHA’s Laura Castellanos, Deborah Holbrook, director of forensic nursing at Mercy Health Services, and Dr. David Maine, president and CEO of Mercy, explained that the key to the success of the program so far is listening to the voices of trafficking survivors.

00:01:22:29 - 00:01:39:08
Laura Castellanos
Thank you Deb for being with us today on this podcast. I'm glad to have the opportunity to talk to you a bit more about your role at Mercy Medical Center and how and why the Blue Dot initiative was created. Can you share with us a bit more?

00:01:39:10 - 00:02:12:20
Debra Holbrook
I would love to. Thank you, Laura. I directed a team of 30 forensic nurses who provide 24/7 coverage for the city of Baltimore for the care of patients who have been victimized by crimes and trauma across the life span, both at Mercy. And we have a fully mobile capacity to all 13 hospitals in our region: nursing homes, prisons, military bases, the Naval Academy for such crimes as sexual assault, asylum for those victimized by torture and persecution, all forms of interpersonal violence, elder strangulation, and, of course, human trafficking.

00:02:12:22 - 00:02:48:21
Debra Holbrook
Mercy's senior leadership values engagement in the community. And five years ago, we became part of a human trafficking collaborative in Baltimore City that included leadership of every federal, state and local law enforcement agency, prosecution, government officials and stakeholders. And Mercy represented medicine because we are the designated center for forensic nursing in the city. And as the team started sharing their needs, there became one common theme that there was no central point of entry or coordinated care response that existed in the Baltimore Washington region.

00:02:48:28 - 00:03:13:22
Debra Holbrook
And as we started educating our staff at Mercy in what to look for in screening for patients who may have been trafficked, we would flag the chart with a blue dot based on the federal government's Blue Campaign to end human slavery. And that's how Blue Dot was created. We see sex trafficking, labor, familial elder, especially gaunt, since COVID and international trafficking at this time.

00:03:13:24 - 00:03:28:01
Laura Castellanos
Thank you for sharing that story, the journey, and you know, it seems like you've had a lot of growth and evolution of your initiative. Can you share with us a little bit more about the changes you've seen since its inception and what lessons have you learned?

00:03:28:04 - 00:03:47:25
Debra Holbrook
Absolutely. This program is constantly evolving and it's based on the voices of trafficking survivors. They teach us everything we need to know to be able to care for them and the needs of our community partners as well. We bring in stakeholders based on the deficits that we see as we care for victims in and around Greater Baltimore region.

00:03:47:28 - 00:04:09:26
Debra Holbrook
We speak with lawmakers to fashion laws that protect our patients, and we hold each other accountable for our respective response when we're called to care for victims of trafficking. This collaborative has grown from 30 to over 60 partners, and I think that's the biggest growth, is listening to what trafficking survivors actually need based on what we thought this was going to look like.

00:04:09:28 - 00:04:18:05
Debra Holbrook
We've seen over 500 victims in just over five years. That is really big numbers in the trafficking world.

00:04:18:08 - 00:04:45:26
Laura Castellanos
Absolutely. And I really appreciate you bringing that conversation of survivor-informed policies, procedures and interventions at our hospitals. And definitely appreciate you bringing to the forefront. I'm going to go to Dr. Maine, for the remainder of our conversation here. I'll come back to you, Deb. But Dr. Maine, I want to hear from your perspective how your leadership has played a role in supporting this initiative, which we just heard, how much it has grown and expanded.

00:04:45:27 - 00:04:47:24
Laura Castellanos
Can you share your thoughts?

00:04:47:26 - 00:05:22:00
David Maine
Sure. Well, first, Mercy is a very mission driven organization. We've had a long history of service to the community dating back to 1874, when six Sisters of Mercy came here to Baltimore. And here we are on the cusp of our 150th anniversary. And we're still doing that very same work, that same commitment through programs like Blue Dot, programs like our Preventative Care Center that opened this past fiscal year through our work in maternal health and of course through providing access to primary and specialty care services here in Baltimore City.

00:05:22:00 - 00:05:44:18
David Maine
And I think as a whole, we work to facilitate engagement, active involvement of our patients in their own care, which enhances safety, enhances quality, and really enhances overall health care delivery. And we're blessed to have amazing people like Deb Holbrook helping lead the way. So at the at the end of the day, this is really about having amazing people.

00:05:44:18 - 00:05:48:22
David Maine
And in committing to that work that started so long ago.

00:05:48:24 - 00:06:09:28
Laura Castellanos
Now, thank you for sharing that background. And, you know, mission-driven, faith based organizations are doing outstanding work in this space. Let's focus a bit on the leadership you've provided, Dr. Maine, and what advice would you give hospital and health system leaders that are actually trying to grow or build capacity to take on some of these anti-trafficking programs?

00:06:10:00 - 00:06:40:27
David Maine
Our forensic nurse examiner program, as Deb chatted about in subsequent Blue Dot initiative, was founded in 1994 by a group of ED nurses. And these nurses...they recognize the need to improve care for victims. And we listened. And so we listened and supported our team members. And so first and foremost, I think you have to have your finger on the pulse of of your community and the needs of that community and recognize where and when you can move the needle on that.

00:06:41:03 - 00:07:08:17
David Maine
The other thing that I think Deb highlighted very nicely is, that we don't do it alone. We use all kinds of stakeholders. And so you have to bring people together to move forward on initiatives such as this. And the other thing I would note is that programs like this are multidisciplinary. There's lots of pieces to it. And implementing anti-trafficking responses require an ongoing commitment of the organization.

00:07:08:20 - 00:07:31:21
David Maine
You need amazing leaders like Deb Holbrook and all of our nurses and recognize that it's not just about the immediate needs of victims, but it's also about the long term implications and the recovery of victims, as well as educating the community about awareness, about resources available. So you can hopefully put it put an end to it as quickly as possible

00:07:31:28 - 00:07:34:18
David Maine
enhancing the wellness of your community.

00:07:34:20 - 00:08:03:18
Laura Castellanos
I appreciate you sharing that. Great advice. And Deb, I want to hear from your leadership perspective. What advice do you have for those? And in my experience, a lot of these programs are created by folks either with the experience or the passion to make a change. And many times we see nurses leading that charge. But from your perspective and in your leadership, what advice would you have for leaders looking to build and grow capacity for these types of programs?

00:08:03:20 - 00:08:32:22
Debra Holbrook
I would suggest that it's really important to educate your staff in the signs of trafficking, but it's more important to first become engaged in a community collaborative. And I'll tell you the reason for that. Medical care providers will stop screening if there's no clear plan for what to do if a patient says yes. Right? So so it's multifaceted that you have to have that plan in place and know who your interdisciplinary team is, that you need to speak with trafficking

00:08:32:22 - 00:08:55:01
Debra Holbrook
survivor was in the early stages of forming your collaborative. The best advice we've had in growing this initiative that have cared for 500 patients is the wisdom of those who have been in this life and what they need. Like we thought we would offer them safety. But most of these patients have ACS scores that are off the charts, and they've never known what safety is.

00:08:55:04 - 00:09:18:21
Debra Holbrook
And of course, ACS is adverse childhood or community experiences that are direct predictors of poor health care outcomes when they become adults. And that's what makes them easy targets for traffickers. But they also it also makes them some of the most difficult patients that we deal with in hospitals. But we need to look beneath the surface of what these people are really going through in their lives.

00:09:18:24 - 00:09:40:24
Laura Castellanos
Thank you for that. You've brought up two really important points: survivor informed and trauma informed care, which is the work that you're leading. And I really appreciate you sharing more about, you know, getting the solutions from from those individuals. They truly have the answers. Again, I want to hear from from both of you as we're taking this podcast to a close.

00:09:40:26 - 00:10:06:01
Laura Castellanos
I want to hear what what do you think are some of the more important areas or important things about implementing anti-trafficking response programs, specifically in health care? And I think Deb, you touched on a good point. If providers don't know what happens after someone answers yes, then then we won't see the type of response that we need. So yeah, if you could give us some takeaways for today's conversation. And I'll go with you

00:10:06:01 - 00:10:07:09
Laura Castellanos
Dr. Maine

00:10:07:11 - 00:10:28:16
David Maine
Sure. Well, what I'll add to this is that I think Deb kind of highlighted it. You need to educate providers, educate your community, educate folks on resources, on the right questions, to ask on the right signals to to see. And of course, surround yourself by the right people to be able to execute well on a program such as this.

00:10:28:22 - 00:10:50:24
David Maine
The Blue Dot initiative is not about awards. It really seeks no recognition outside of the wellness and safety of victims. So you do this because you want to do this because you need to do this because the community needs it. And so we're very proud to work with these amazing nurses and support them fully in this incredible work.

00:10:50:27 - 00:11:16:18
Laura Castellanos
Absolutely. We're proud of the work. And it is worth mentioning that the Blue Dots human trafficking initiative at Mercy Medical Center in Baltimore did receive the 2022 Presidential Award for extraordinary efforts to combat trafficking in persons. So it is worth taking a moment to recognize that outstanding recognition. Deb, I'm sure you are proud. So for our listeners today, what takeaways do you have to share with them?

00:11:16:21 - 00:11:39:02
Debra Holbrook
I have a couple. First of all, these patients of trafficking have no reason to trust us. Anybody who's ever been somebody that they thought they could trust has abused them, right? They're taught to fear law enforcement, but not health care providers. And we need to come with to them with being non-judgmental because, again, they are the most challenging cases we see.

00:11:39:04 - 00:12:14:19
Debra Holbrook
We need to respect our community partners who work with us. We've trained over 600 medics and they are now by what they see in the field, bringing us at least one victim a week. That is huge based on mandatory training that you need to involve your liquor board and fire inspectors...that you need to remember elders are being trafficked at a higher rate than ever, and that is not a population that we traditionally look at for sex and labor trafficking> That to start with an open mind that this is not what you expect it to be and never show shock when these patients decide to disclose.

00:12:14:21 - 00:12:28:13
Debra Holbrook
And lastly, a mutual respect for the lives that our patients are living, albeit cruel and heartbreaking, that we are their lifeline. And we're so grateful that Mercy leadership lives its vision to community care in our most vulnerable patients.

00:12:28:15 - 00:12:51:09
Laura Castellanos
Thank you for sharing so much wisdom and insight from the field. You're right, health care providers are not here to rescue. But you are that lifeline. And we are working as a field with partners to ensure that the resources, the education, the tools become available. As I mentioned, the American Hospital Association has the Hospital Against Violence Initiative that has a combating human trafficking effort.

00:12:51:09 - 00:13:00:12
Laura Castellanos
And we are going to be so glad to be sharing this great podcast. We appreciate you both coming on and sharing your insights and more about your leadership.