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This activity qualifies towards Michigan State Licensure requirements for Human Trafficking.

Featured guests: Bridgette Carr, J.D., Human Trafficking Clinic at Michigan Law, and Michelle Munro-Kramer, Ph.D., CNM, FNP-BC, School of Nursing

Objectives

• Define the different types of human trafficking
• Identify those at risk of being trafficked

Resources

• University of Michigan Human Trafficking Collaborative

CME

Credits available: 0.75

Visit our CME course overview page for CME credit or complete this survey for social work CEUs.

Transcript

Dr. Christina Cwynar:

Hello and welcome to our podcast, Breaking Down Mental Health, with myself, nurse practitioner Dr. Christina Cwynar, child and adolescent psychiatrist, Dr. Heidi Burns, and social worker, Syma Khan. We are joined today by Dr. Michelle Munro-Kramer and Professor Bridgette Carr to focus on the basics of human trafficking.

Dr. Heidi Burns:

Dr. Michelle Munro-Kramer is an assistant professor, the Suzanne Bellinger Feetham Professor of Nursing and the Director of Global Programs at the University of Michigan School of Nursing. She's a certified family nurse practitioner and certified nurse midwife, and practices per diem at the Washtenaw County Health Department. Her program of research focuses on gender-based violence prevention and response, primarily among college-aged youth within domestic and international context.

As part of the inaugural Johnson & Johnson Nurse Innovation Fellowship, she is interested in leveraging nurses' creativity to develop innovative solutions to complex health and human rights issues, such as intimate partner violence, sexual violence, and human trafficking. Her research projects approach these topics using a trauma informed and patient-centered lens. She uses mixed methods and participatory action research to understand the experiences of vulnerable populations in order to inform intervention development. Her global health field work has included Ethiopia, Ghana, Liberia, and Zambia.

Syma Khan:

Professor Bridget Carr founded and directs the University of Michigan Law School's Human Trafficking Clinic, the first clinical law program solely devoted to addressing this issue comprehensively. Since 2009, Professor Carr and her students have provided free legal services to survivors of human trafficking. They support the wide ranging needs of men, women, and children, both foreign nationals and US citizens, who have been victimized by a range of trafficking crimes. Using the U of M Clinic as a model, Professor Carr is working with university partners around the world to develop similar programs to combat human trafficking and train law students, and has helped established university law clinics in Mexico and Brazil to broaden the network of legal experts who can address the issues of compelled service that transcend international borders.

She's the lead author of the first case book on human trafficking law and policy, which examines a cross-section of criminal justice, civil and human rights, immigration, and international law that frames these issues. Professor Carr regularly provides human trafficking training to law enforcement, government officials, and healthcare providers, as well as consultations to state, national, and international authorities on the issues of human trafficking. None of the speakers here today have any conflicts of interest or financial disclosures. Thank you to both of our speakers for joining us today.

Dr. Michelle Munro-Kramer:

Thank you for having us.

Dr. Christina Cwynar:

Dr. Munro-Kramer, can you talk a little bit about what human trafficking is, and what the different types of trafficking are?

Dr. Michelle Munro-Kramer:

Sure. In the most simple terms, human trafficking is compelled service. Essentially, it's fueled by supply and a demand. There's a demand for cheap labor, whether it be in a nail salon, creating clothing, or for commercial sex, and traffickers basically exploit individuals to create that human labor to fill the supply gap. The main types of human trafficking that we focus on are labor trafficking and sex trafficking, although there are other forms recognized, like organ trafficking and forced marriage. But, what we primarily see in the United States would be labor trafficking and sex trafficking.

Professor Bridgette Carr:

Yes, I think there's a lot of terminology, and we'll probably say more in our discussions. You'll hear the phrases modern slavery, forced labor, exploited labor. It's really just all talking about people with power taking advantage of someone with a vulnerability in order to commercially profit.

Dr. Heidi Burns:

Thanks for that broad definition and condensing it down for us so that we can understand what we're really talking about today. Because I think, especially if you're within healthcare, you've been hearing a lot about human trafficking, and sometimes I think we don't think about how broad it really is.

Professor Bridgette Carr:

I think it's so broad and it's also so pedestrian, meaning when I hear people talk about human trafficking and they don't know what I do, it's like they're talking about a unicorn. I mean, I really think that they're talking about unicorns. That it's magical, that it's exotic, that it's rare, that you're almost never going to see it, or when it presents itself, it's going to present itself in a way that you've never seen anything like it before. It's really a horse. It's super pedestrian. I've seen it lots of times. We probably drive or walk by it, and you don't even think twice about it. I think when we talk about trafficking as if it's a unicorn, we are training people to look for something that doesn't exist, because the reality is our society is built on the pursuit of cheap goods and labor, and so of course we're going to see the folks who provide those cheap goods and labor all around us.

Dr. Heidi Burns:

Which I think puts a good spotlight on the fact that it's actually commonplace. It's something that you probably would see a lot, potentially in an emergency department, and why some of the trainings and awareness around it is actually really important.

Dr. Michelle Munro-Kramer:

I mean, I think it's in any part of healthcare, not just the emergency department, and that's actually probably one of the myths we perpetuate, is that in order to have individuals that can perform labor, you want them healthy so you're going to take care of any of their healthcare needs, whether it be problems with their teeth, reproductive problems, mental health problems, or actual physical problems. I mean, I think in healthcare we see many individuals who have experienced different forms of interpersonal violence, and we don't think of that as uncommon, and this is just another form of interpersonal violence that could present itself.

Professor Bridgette Carr:

I think the other thing we don't want to forget about is it's definitely the folks that are being taken care of in the healthcare setting, but also could be the folks that we work with. Whether it's a nurse that you're working with or someone who is cleaning the room that you have examined someone in, we know of cases involving cleaning people and nurses. I just think we can't forget that it's not just about the folks that healthcare providers are serving, but it's also potentially anyone in the healthcare provision ecosystem.

Dr. Michelle Munro-Kramer:

I think that's consistent, again, with any form of interpersonal violence. We like to think about someone else experiencing intimate partner violence or sexual assault, but it really is surrounding us all the time.

Dr. Heidi Burns:

On that note, thinking about the fact that it probably is a bit ubiquitous, it's around us, what are some of the common trends that we might actually see with human trafficking day to day?

Professor Bridgette Carr:

I think when people ask that question, it's a common question that I get. They want a checklist, they want the top five indicators, or they want one question they can ask that can help screen. We just don't have any of that. Some of that is really the fault of the anti-trafficking movement. There are no evidence-based indicators for how to know if human trafficking exists. There are no validated individual screening questions. There are screening tools for healthcare settings, but they are impossible to implement. I think one of them is 16 pages long, it's absolutely not practical. I do intakes quite often in the Human Trafficking Clinic at Michigan Law School. We don't use a 16 page intake form.

I really want people to think about, especially healthcare providers, think about when you are in an exam room or you're with someone and you sort of get that feeling in your gut that's like, something's off here. Perhaps historically you might run through, is it IPV? Is it sexual assault? Is it child abuse? Whatever the labels are that you already have in your toolbox, I just want you to add human trafficking into that toolbox. I want you to think about that, if the thing in front of you doesn't fit the frame that you're used to, if you can't identify someone who's in their family who's harming them or it's not a child parent narrative, but it's some narrative where you're seeing exploitation, it might be human trafficking. This person's vulnerability might be used against them for the person to profit.

When I talk to healthcare providers after I train them all the time, folks say, "That's happened to me. I've had that uh oh feeling, and it just didn't fit the labels I knew to use, so I didn't know what to do with it." I think the important thing is to say this is not unlike things you already know, so you already know how to handle most of this. It's get in contact with the social workers on your team, reach out, know what the plan is if someone comes into your setting to address these issues, and that you don't have to know the ins and outs of the definition to be a help to someone you might encounter.

Dr. Michelle Munro-Kramer:

I think the other piece is expanding the idea of who your team is. We think a lot about working with social workers for different types of concerns related to trauma or mental health. But, I mean, your team is also the individual at registration who's checking in a patient and recognizes that someone's answering for them, and the questions, the identification, or a number of other things. I think it could be the person cleaning up the room that notices something. Really expanding this idea of the team and what others might be seeing too.

I've had a colleague who had this kind of uh oh gut feeling, something was off, and just really couldn't put their finger on it. Then later when consulting with another member of the team, they had gathered completely different information, and when put together, they're pretty sure that human trafficking could have been happening. I think that's the other piece. Whenever you have that feeling, who can you talk to? Who can you share with and see if they've learned anything else that you might be able to put together to understand the situation and what the patient is going through in a little more detail?

Professor Bridgette Carr:

I just want to add one more thing, too. Perhaps all that you identify is child abuse or IPV or sexual assault. Many human trafficking cases have all of those elements as well. I worry sometimes in this space that we act as if there's something magical that will happen if you use the human trafficking label. It's not like resources rain down from the sky if we've labeled it human trafficking. I would be elated if all of my, let's just say, sex trafficking clients were actually labeled as sexual abuse victims, be elated for a variety of reasons, but I'll be elated if they were identified that way, because it means their pain and harm was seen. I don't need folks to know every single legal definition that can apply to my clients. I just need them to be seen as someone in need of help.

Dr. Michelle Munro-Kramer:

I would add one more thing, Bridget, on top of that. I mean, so you said you'd be elated if your clients were labeled as sexual abuse victims. I think we have a lot of implicit bias. We make a lot of assumptions about people, and so when we're presented with information like a number of sexually transmitted infections or sex partners, instead of questioning why that might be, we sometimes make assumptions about a person, and don't go to, is there abuse? Is there something happening to that person, as opposed to wanting to label them, which we do a lot in healthcare.

Dr. Christina Cwynar:

Do you think you could speak a little bit more about that implicit bias? What are we seeing when somebody is labeled maybe as trafficking versus abused?

Dr. Michelle Munro-Kramer:

I mean, I think there's a lot of myths and misconceptions about human trafficking. As Bridget said, we try to put this picture or checkbox in our head. We might be looking for someone that has a tattoo with a name or a bar code, which is completely false. There are many individuals around the world with tattoos, it has nothing to do with human trafficking. Whereas when we're thinking about sexual assault or abuse, I think the media has really helped to push this narrative of this white girl that has been taken away by a stranger. I think we create these misconceptions because we don't want to believe it can happen to us or to our friends, when really, any type of violence, including human trafficking, can happen to anyone around us. Again, not thinking about how someone looks, how they're presenting. Really thinking about what happened to them, and what might have preceded that. What could we be missing from the story that they haven't shared or maybe are a little unwilling to share because we haven't established a safe trusting space to do that yet?

Professor Bridgette Carr:

I think especially in the cases involving sex trafficking, and let's be very clear, sexual abuse can happen in labor trafficking as well. But, in the sex trafficking cases, I don't know what happens to folks' thinking, but there's something about money on the nightstand that changes where people think the power lies. I can tell a narrative of a 16 year old girl engaged in sex with a 50 year old man, and if somehow money is exchanged, that girl is somehow super powerful. She has all this power and she should be charged criminally. Now, we may not think that in this room, but that narrative exists.

But, then if I told that same story but there was no money, and that 50 year old man was engaged in sexual relations with a 16 year old girl, people might have a very different reaction. I often say, "Please explain to me how $20 on the nightstand changes the inherent power dynamics in what I've just described." It doesn't, but for some reason in our culture, it does. What I often say to people is, if you are working on a case involving commercial sex, so a case involving sex trafficking, ask yourself if you are comfortable with your reaction if no money was involved. Try to take that commercial aspect of those sexual acts off the table, and are you comfortable with what you're choosing to do?

Syma Khan:

Thank you both so much for those reflections. I think it's really important to question our own implicit biases, the judgements that we make in moments. That financial component, it suddenly does add some kind of control in that situation, that this person maybe is more doing something more so voluntarily because now they're being compensated in some capacity. Clearly, there's still the significant lack of control. There's a power dynamic that we need to be aware of and we need to ensure we're addressing. I think shifting a little bit, I know there's not necessarily a template for who's trafficked, or easy to say, "Look for someone that's this age range, this demographic, this racial or ethnic identity," but are there specific groups that are more likely to be trafficked or that are vulnerable to be trafficked?

Dr. Michelle Munro-Kramer:

Again, I would just reinforce that anybody can experience human trafficking. I do think that traffickers exploit vulnerabilities, whether or not they're visual vulnerabilities that we might see is a different story. That could be somebody who's looking for an education and doesn't have a means to achieve that. Bridget and I coincidentally met in Ethiopia, and when we were doing some work exploring human trafficking and Ethiopia, that was what we were seeing in the northern part of the country. There were limited economic and educational opportunities, and so traffickers were preying on that. But, I think that looks differently based on the region or the individual. I mean, we hear a lot that runaway youth or homeless youth are particularly at risk. They might be at risk because they might trust people who are exploiting those vulnerabilities, but again, anybody can be at risk.

Professor Bridgette Carr:

I think you really have to look at power dynamics. I mean, I think there is one thing that is a quick rule of thumb. The majority of labor trafficking victims are not US citizens. We have only represented one US citizen who's a labor trafficking victim. Sex trafficking victims have been both US citizens and foreign nationals. We've represented men, women, and children. But, I think when we talk about vulnerability, we often sometimes think at first of poverty, foster care, lack of education, foreign national status. But, I also want us to think a little bit broader. Let's think about foreign national students here on their PhD. If you're here on your PhD, your advisor, your faculty member has tremendous power and control over you. We have represented people who have been trafficked by their PhD advisor. We have represented people in healthcare who are here on visas, because your employer has so much power over you, who have been trafficked.

We have represented athletes who have been trafficked, because when you are an elite athlete, the number of avenues available to you to achieve your goals are very narrow. I mean, let's all think of the Larry Nasser case. If you want to be an Olympic athlete, you can't take your hometown volleyball coach with you. You have to use the doctors, the coaches, the facilities that the US Olympic Commission requires you to do so. We don't think about those athletes as being vulnerable, but they actually are. I want us to make sure we have a really broad frame for what vulnerability looks like, because I do worry a bit that then we start to say, "Well, if they're not poor and they're not brown and they speak English, they can't be trafficked." That's just not the case. Unfortunately, people who are willing to profit off of other people's vulnerabilities are all around us in society.

Dr. Michelle Munro-Kramer:

Bridget, I know you've done some work online too, and just identifying victims and preying on individuals online, and how that space completely takes away identity and utilizes the online venue more as the means to exploit individuals, regardless of who they are, what they do, or what vulnerability they have.

Professor Bridgette Carr:

Yes. I mean, I think one of the myths around trafficking is that it's strangers who traffic us. That it's a white van in a Target parking lot that grabs people, or there's hidden codes based on stickers on bumpers. If only, I mean, my God, how I wish that's what trafficking was like, because you know what? If trafficking was white vans snatching middle class girls from Target parking lots, one, it would be all over the news, all the news, all the types of news. Two, there would be so much surveillance video available for it. It would be Target's surveillance video, it would be all the people with iPhones in the parking lot. We would have so much evidence, but it's not strangers who traffic people. It's people that love and trust.

We actually surveyed all the cases that we've ever done in the Human Trafficking Clinic. 98% of our cases, our clients were trafficked by someone they knew, loved, and trusted, 98%. I think in all the cases I've ever done and consulted on and been talked to about, there's only one case involving someone who was physically kidnapped, and the person was not kidnapped in the United States, it was in a foreign country. I think that's the myth, that the danger is the person that we don't know, and not at all. The danger is the person who's willing to take advantage of you for money, and the danger I think for all of us is that we're willing to ignore folks' vulnerability because we're happy with low prices.

Dr. Michelle Munro-Kramer:

Well, and the people that know your vulnerabilities the best. Right?

Professor Bridgette Carr:

Yes.

Dr. Michelle Munro-Kramer:

When we talk about vulnerabilities being so broad, who knows our weaknesses the most? It's the people that really-

Professor Bridgette Carr:

Or the people we trust online who we think are one thing and there's something else. I'm a mom, I have three young kids. Other parents will say to me, "How are you keeping your kids safe from trafficking? Aren't you worried they're going to be snatched?" Well, one, I'm not worried they're going to be snatched, because we've established that is not a thing. But two, I actually say, "I'm actually more worried that you all are talking about stranger danger. I'm more worried that you're not willing to talk to kids about what their body parts actually are and you're naming them these whackado things." Let's say the words of what they are.

I'm more worried that we aren't empowering our kids to say, "You know this person I love? Grandpa touched my vagina." I want my kids to be able to say, "Grandpa touched my penis," or, "grandpa touched my vagina." Empowering your children to say, "This person who cares about me hurt me," and letting your kids know that as a parent you can handle even how big or how hard that sentence is, that's fighting trafficking. Because the person who's going to try to pray on your kid online, then, is going to have no place for that prey to land.

Dr. Heidi Burns:

I think we've actually encountered a lot of that within the inpatient child psych setting, where we have family meetings with people and they don't realize the extent of the online presence of their child, and they end up actually having a lot of contacts, a lot of grooming and things that are occurring online of under their parents' nose. We talk a lot about trying to be more connected and communicate more with your child, be a partner in their online use and try to instill some of that knowledge about what to look for. Because, unfortunately, we do see that very commonly.

Professor Bridgette Carr:

I wish we wouldn't call it grooming, though. You weren't wrong to call it that, because that is what it's called. But, I even think grooming takes it into this fantastical, it's super evil. I mean, it is evil, the objective is evil. Super nefarious, and it's got all these tentacles. I just have this visual image in my mind of what grooming looks like, when grooming's really like, "Hey, how was school today?" It's building a relationship.

Dr. Heidi Burns:

Sometimes it's so simple. It's just, "Oh, I've been talking to this person for two years online, they're my friend. They love me."

Professor Bridget Carr:

It's building a relationship. If we talked about it as pay attention to who your kids or who vulnerable people are building relationships with, then it's a completely different ballgame. But when we say grooming, I just think it becomes this shadow thing that folks think, "Well, those aren't the places my kids go online," or, "that wouldn't happen to my kids because they know good people." It's building relationships. I try to say that now instead of grooming.

Syma Khan:

I think so often, teenagers want someone that they can trust and understands them, and those are the types of things that I think these individuals utilize. I think when we think of grooming, it's always this older person, it's really this grandfather, this older, but it may even be someone that's maybe only several years older than them. But again, there's this power dynamic, there's control that's being utilized in that setting. I think really taking a step back and acknowledging that these behaviors occur in a multitude of settings and different ways, and it's again, that relationship and that trust and support that that child is looking for.

Dr. Heidi Burns:

Yeah, we see a lot of kids who, they don't feel connected to their family or their friends that they have at school, and their online relationships are everything to them. Sometimes those are truly good friends that they make, and sometimes they're not. But, just trying to educate the parents to be involved at least and try to make sure they're aware of what's going on under their nose.

Professor Bridgette Carr:

Yeah, I mean, when I read what traffickers think about how to target their next victim, they talk about the kid who's lonely, labor or sex trafficking, the kid who wants a connection or the adult. When you can walk through the world, if you will, with the eyes of a trafficker, and I think this even sometimes when I walk on campus here, especially with young girls who look like they're trying not to take up space or they look so lonely, and I want to be like, "Take up space. Meet people, connect, talk," because gosh, traffickers don't even want to mess with the hard targets, meaning the kids who are going to make a big fuss. There's just so many easy targets out there, that it's not hard for traffickers to find people who they don't have to snatch, who will "willingly" get in the car with them.

Dr. Michelle Munro-Kramer:

I think the other piece beyond the language is, I mean, the language to talk about different forms of violence. We always think if we talk about it's going to happen, or that it's a sensitive topic and we shouldn't be talking to our kids about it. But, then they don't have the language to describe. They get these complex definitions, they don't really understand what's happening, and so they can't even tell you what's happening to them or recognize that something. It's that gut feeling for them, too. If they have someone who they're just bonding with online, and they are playing a game, and they're sharing what they like and don't like, that's very different than being able to recognize somebody constantly questioning them. Who's your family? What's going on with you? What's this? What's that? I think we don't empower our children a lot because we think we're protecting them from these words or these terminologies or these bad things that can happen in the world, but they can happen to anybody. We're doing more of a disservice by not talking about it.

Professor Bridgette Carr:

There are ways to talk about it that aren't terrorizing. In my family, one of our big, big messages is we don't keep secrets, but we can have surprises. We can have a surprise gift for someone, but if any adult asks you to keep a secret, that's a big sign that you need to talk to mom or dad, or someone else if you're not comfortable with mom or dad. The other thing we talk about a lot is, you know what? Adults can ask other adults for help. Sometimes my kids throw that back about unloading the dishwasher, but we talk about it in the context of another adult does not need you to help them to do their job. That's not using phrases like sexual assault and all that stuff, but it's just right away talking about there are realms that are for adults and there are realms for kids, and let's talk about open lines of communication with us and how people might try to step into those spaces where parents should be or legal guardians.

I think the other thing that we do is we don't shy away from hard topics, but we try to talk about them in ways that are kid appropriate. It's not a secret to anyone, there's been a significant amount of sexual harassment and sexual abuse on campus at Michigan. My kids talk about that as butt touching. I'll come home and I'll be upset about something, and my eldest will be like, "Oh, was there another butt toucher?" For some reason that's how they, I think he was eight when he started using that, as an eight year old, he conceptualized it. It's not appropriate for adults to touch other people's butts at work, and then I talk about it. "Yep, there is, and this is how it wasn't okay." Then he'll say, "Why didn't anyone speak up?" We talk about that. We talk about how uncomfortable community speak up. I think some people laugh when my kids say, "Is it butt touching again?" But, it's a way that he can have those conversations and he can access it without knowing all of the details.

Dr. Michelle Munro-Kramer:

I mean, there's so many things you can do early. Like consent.

Professor Bridgette Carr:

Yes.

Dr. Michelle Munro-Kramer:

I mean, consent. You don't have to hug grandma if you don't want to.

Professor Bridgette Carr:

Totally.

Dr. Michelle Munro-Kramer:

Just understanding the choice and that if you're uncomfortable, you have the ability to say no and talk to an adult about it. The body parts, I mean, you can do that right away. Instead of creating these kind of funky, what did you say, whackado names that are then difficult for others to recognize what's going on as well. I mean, I think the other thing is the news. I mean the news lately, if it accidentally is on, I have a four year old and she's like, "What's that? What's going on?" There's so many things that you can equate. Black Lives Matter, we went to a march and we tried to talk about what that means. I mean, Sesame Street did an amazing special on that. There's a lot of ways to break down these hard topics to kids, and I think the media is trying to do a better job of that as well, that we can't just keep ignoring it and saying, "Oh, you'll learn about that when you're an adult," because by then it's too late.

Professor Bridgette Carr:

I think the other big one is learn about how your kids' daycare and school are talking about these issues. I actually asked to see all these trainings, and one of the big changes I requested for my kid's school was all the examples of when you tell a teacher involved another child. I said, "You need some examples in there of bad behavior on the parts of school administrators and teachers." Those kids have to know that if an adult makes a mistake or does something wrong, that they can go to another adult at the school. It had never occurred to them that every single example was about telling on another child, and never on an adult. It's like a subtle shift, but it really opens up what kids learn that they can do to get help.

Syma Khan:

I think just reflecting that oftentimes if you're not having those conversations, at some point your child is going to have that conversation outside of the home. Having that yourself and identifying the ways that as a family you'd like to talk about it, is probably easier and better than going to the internet or other friends or other settings where maybe then they're victimized or they're put in a vulnerable situation.

Professor Bridgette Carr:

For sure.

Dr. Michelle Munro-Kramer:

I mean, I think the other age group we don't always think about is the over 18, the college age, the 18 to 24. They're adults, but they're still learning a lot about this, and they're probably starting to learn how they will educate their family and what they're going to do for their future families. I think there's a lot of potential there. Just having these conversations, getting them involved with organizations, we've had some students who have volunteered with the Washington Area Council for Children and have talked to kids about consent and what that looks like. At first, they did it a little begrudgingly, but afterwards they realized, "Wow, this is so powerful. I learned things, I could take this with you the rest of my life for any child I interact with." I think we sometimes think it's too late for that age group to have some of those conversations, and I think they're a really important age group as well.

Dr. Heidi Burns:

We've talked a lot about the parent-child interaction that you can have around human trafficking, but circling back to providers and thinking about the audience that we're reaching out to in this podcast, what are some things that you might recommend or think that providers should be thinking of or potentially asking?

Professor Bridgette Carr:

I've seen all the indicators, I've looked at where they've come from, but I think one of the most important things is to, in some ways, think a trafficker a bit and then try to disrupt that script. I think, how can we disrupt the script? For example, one of the indicators that healthcare providers are often trained on are, did your client not know their address? Well, every single one of my clients has an address to provide to a healthcare provider, because a trafficker knows a healthcare provider or multiple people in the healthcare provision setting are going to say, "What's your address?" They're going to give you an address. My three year old could give you an address. We train people to answer that question.

What many of my clients could not do was describe how to get to where they sleep at night. It's a very subtle shift in that question, but it's disrupting the script of what traffickers expect they're going to be asked. I often try to say if you just do the right thing, what's your address, or another one is, do your patients not have control of their money? Well, most of my clients would say they had control of their money, but then if I said to them, "If you needed to get a hundred dollars right now, could you describe to me how you'd have to do it?" Many of them would say, "Well, I'd have to go to so and so and ask them because they hold my money to keep me safe." It's flipping that script a bit, because some of those well worn tips for indicators that we give folks are just so easy for traffickers to make sure their victims have answers to.

Dr. Michelle Munro-Kramer:

I think the other thing I would add on Bridgette, is to me the goal is not to get a disclosure. The goal is to establish yourself as a safe place to come back to if someone needs support for healthcare, to get out of a trafficking situation, or just needs resources. I think that goes with any age group, that regardless of the questions that we ask or how we ask them, that that's not the end goal. The end goal isn't to get a good disclosure, because there's a lot to do after that as well. It's really to create the safe space for patients and their families to come back to.

I think the other thing I would add is we've been talking a lot about families, and I don't want to put blame on families or others. That, again, trafficking is something that happens to people, and it's not their fault. Thinking about trauma informed care, it's what happened. It's not what did you allow to happen or what's wrong with you, and that goes, again, for the patient, their family, whoever's involved. These conversations we've been having about language and talking to children early about what might be happening in the world, I think those are important tools, but it's nobody's fault if trafficking still happens, because unfortunately it does still happen.

Professor Bridgette Carr:

Well, it is the trafficker's fault.

Dr. Michelle Munro-Kramer:

It is the trafficker's fault.

Professor Bridgette Carr:

That is the person we tend to think least about the actions, thoughts, and choices of.

Dr. Christina Cwynar:

I really like how you framed that, and we've talked in previous episodes about trauma informed care as well. Looking at these individuals through that lens and how we can support them in these moments, and how we can support their family or whoever else is in the situation, is really important. We've talked about a lot of different things and aspects of human trafficking today, but do either of you have any further thoughts that you would like to share with our audience?

Professor Bridgette Carr:

I think my biggest takeaway that I hope folks hear today is that you already know how to do this. You may not have used this label, but you've already seen these folks in your settings, and maybe you identified them as a victim of something else, or maybe you didn't at all. Hopefully next time you might, or most importantly, as Michelle said, you made them feel welcome and safe. This is not new. This is not new. Just know that we all get it wrong, myself included, and we all hope to do better the next time.

Dr. Michelle Munro-Kramer:

I guess I would say don't be swayed by some of the myths and misperceptions. I think as healthcare providers, we are taught and we really like to have good indicators and a checklist, because that make things a little bit easier. But, that's not the case with human trafficking. I just want us to be careful of believing everything we read. Michigan is not the number two hotspot for human trafficking, there's no data to support that. But, I think we get these ideas in our head and then we run with it. Just checking your own biases, questioning things that you read about trafficking to ensure you have accurate information, just like you would with any other type of healthcare problem.

Dr. Christina Cwynar:

Well, thank you both for joining us today. I think you answered a lot of questions of our audience. I know I learned a lot today. We truly appreciate your time and your expertise. Thank you to everybody who tuned in this week. Nurses, social workers, and physicians can claim CMEs and CEs at UofMhealth.org/breakingdownmentalhealth. You're able to do this anytime within three years of the initial air date, and we hope you will join us next time.