This text-based course is an edited transcript from a live webinar presented by Sophie Nathenson, PhD.
This material is for educational purposes and does not replace clinical judgment or local policy.
Course Overview
This course provides health professionals with a comprehensive framework for understanding and identifying human trafficking in the United States. Grounded in a sociological perspective, the material examines the complex definitions, scope, and societal factors that contribute to trafficking. Participants will learn to recognize the physical, behavioral, and psychological indicators of trafficking in both adult and minor victims, with a specific focus on signs that may present in healthcare settings. The course offers practical guidance on trauma-informed communication, clinical assessment, and the use of national resources to report suspected cases and support vulnerable individuals.
Learning Outcomes
After this course, participants will be able to:
Describe the different types and venues of human trafficking prevalent in the United States.
Explain at least two risk factors and warning signs, including social and systemic factors, of human trafficking for both adult and minor victims.
Identify five specific indicators of trafficking that can be identified in healthcare settings and appropriate resources and protocols for reporting suspected cases.
Risks/Limitations
Generalization of Trends: Trends presented change over time and population.
Limited Cultural Representation: The course may not fully encompass the diversity of experiences with human trafficking or the regional or global scope and differences.
Research Scope: This course does not contain an exhaustive review of research conducted on these topics.
Definitions of Human Trafficking
Understanding the formal definitions of human trafficking is the first step in distinguishing it from other related criminal activities. These definitions provide the legal framework for identification, reporting, and prosecution, establishing clear boundaries for what constitutes this severe violation of human rights.
Federal Definitions
The primary federal legislation governing human trafficking in the United States is the Trafficking Victims Protection Act (TVPA). First enacted in 2000, this act establishes clear definitions for the main forms of trafficking and provides a framework for prosecution, protection, and prevention (U.S. Department of Justice, 2024).
Sex Trafficking: This is defined as the recruitment, harboring, transportation, provision, obtaining, patronizing, or soliciting of a person for the purpose of a commercial sex act, where the commercial sex act is induced by force, fraud, or coercion.
Labor Trafficking: This involves the recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery.
A critical provision of the TVPA relates to minors. Any individual under the age of 18 who is engaged in commercial sex is legally considered a trafficking victim, regardless of whether force, fraud, or coercion can be proven (U.S. Department of Justice, 2024). This removes the burden of proving manipulation in cases involving children, acknowledging their inherent vulnerability. Beyond these two primary categories, other forms of trafficking exist, including child trafficking for non-sexual labor, bonded labor (debt peonage), forced marriage, and organ trafficking.
Michigan State Law
State laws often provide additional specificity that reflects local priorities and legal structures. For example, the Michigan Penal Code defines human trafficking as the knowing exploitation of an individual, with a particular focus on vulnerable populations (State of Michigan, 1931). The key element in this definition is the concept of "knowingly." A person is not culpable if they are caught in a situation without awareness of the context or details of the exploitation.
The Michigan statute includes specific actions, such as:
Benefitting financially from the exploitation.
Controlling an individual's access to controlled substances as a means of coercion (State of Michigan, 1931). This tactic is a common method used to maintain control over a victim, creating a physiological dependency that compounds psychological manipulation.
Distinctions from Other Crimes
Human trafficking is often confused with other serious crimes, but its methods and motivations are distinct. It is not always a violent crime, and the signs of abuse may not be physically visible. While violence can be a component, psychological control is often the primary and most powerful tool.
Smuggling: This crime involves providing transportation across a border, typically with the consent of the individual being transported. While dangerous and illegal, it is not trafficking unless the relationship transitions into a situation of force, fraud, or coercion after the transport is complete. Smuggling is a crime against a nation's border, whereas trafficking is a crime against a person.
Kidnapping: This typically involves taking someone against their will for a specific purpose, such as a ransom. The motivation is often a one-time event or payment, whereas trafficking is an ongoing form of exploitation for labor or commercial sex.
Trafficking is far more likely to rely on psychological means of control rather than physical restraint. These tactics include manipulation, defrauding individuals with false promises, and making threats against the victim or their loved ones (Eryarsoy et al., 2024). This sustained psychological pressure paralyzes individuals, preventing them from seeking help even when physical escape appears possible.
Tactics
The methods used by traffickers are often subtle and designed to break down a person's autonomy over time. Psychological means are more common than physical confinement, particularly when a family member is the trafficker, as the pre-existing emotional ties can be powerfully exploited (Eryarsoy et al., 2024).
Common tactics include:
Fraud: This involves making false promises to lure a victim into a situation of dependency. Examples include offering a good job with a specific salary, a safe place to live, a marriage proposal, or support for their family. Once the victim is isolated, these promises are broken, and the exploitation begins.
Threats: Traffickers frequently use threats to maintain control. This can include threats of physical violence against the victim, threats of harm to their family members and loved ones, or threats of deportation for undocumented individuals. The fear these threats generate can be a more effective restraint than any physical barrier.
Debt and Intimidation: Many victims are trapped through debt bondage. A trafficker might withhold pay, create a fraudulent debt for transportation or lodging, hold personal documents like passports or identification as collateral, and use various forms of intimidation to ensure the "debt" can never be repaid (Eryarsoy et al., 2024).
Sociological Perspective
To effectively identify and prevent human trafficking, it is essential to look beyond individual cases and examine the broader societal conditions that allow it to flourish. A sociological perspective focuses on the "upstream" factors—the social and systemic issues that create vulnerability in the first place. This approach studies group differences rather than individual pathologies to understand how belonging to certain demographic groups can increase risk. This view shifts the focus from asking "What is wrong with this person?" to "What is happening in our society that allows this to occur?"
This perspective emphasizes several key areas:
Social Factors: These include a person's demographics, such as race, gender, sexuality, marital status, and employment status. Analysis of these factors can reveal patterns of vulnerability within a population.
Prevention Focus: By examining upstream factors, the focus shifts from intervention to prevention. Addressing the root causes of vulnerability—such as poverty, lack of education, and discrimination—can reduce the pool of potential victims.
Systemic Factors: These are issues embedded within our societal systems, such as healthcare, education, and justice. A lack of access to resources, for example, is a systemic factor that can increase an individual's risk of being trafficked.
Role of Institutions: This involves analyzing how institutions like schools and hospitals can either contribute to a person's vulnerability or serve as critical points for identification and support.
Social Environment: A person's environment—including their family, neighborhood, and experiences with discrimination—profoundly affects their psychological and even physiological well-being. A hostile or unstable social environment creates the fertile ground in which traffickers operate.
Role of Behavioral Health Professionals
Behavioral health professionals are uniquely positioned to identify and support victims of human trafficking. The growing awareness of this issue has highlighted the critical role clinicians play in the response system, serving as a potential lifeline for individuals who may not encounter other service providers.
Key responsibilities include:
Mandatory Reporting: Professionals must be aware of and comply with their state's mandatory reporting laws regarding suspected abuse and trafficking, particularly concerning minors.
Identifying and Supporting Victims: This involves recognizing the subtle signs of trafficking and understanding the resources available to help victims.
Addressing Consequences: Clinicians must be prepared to address the specific and severe mental, physical, and emotional consequences of trafficking, which often manifest as complex trauma.
Providing Trauma-Informed Care: It is crucial to use a trauma-informed approach to avoid re-traumatizing victims during assessment and treatment.
Collaboration and Coordination: Effective support requires collaboration with specialized organizations, law enforcement, and social services that are equipped to handle trafficking cases. No single provider can meet all of a survivor's needs.
Empowering Vulnerable Individuals: A key prevention strategy is to empower at-risk individuals by providing them with the support and resources needed to reduce their vulnerabilities before a trafficker can exploit them.
Identification
Identifying victims is a challenging but critical task. Traffickers are skilled at manipulation, and victims often do not self-identify due to fear, shame, or psychological control. It is a misconception that trafficking only occurs in other countries; it is a significant problem within the United States.
Victims who are not believed or are met with inadequate responses from institutions can experience re-victimization, which reinforces their sense of helplessness and distrust of authority. A major barrier to identification is the stigma associated with the circumstances of trafficking. Labeling a victim as a "criminal," "delinquent," or "prostitute" prevents professionals from seeing the underlying coercion and exploitation. Overcoming this stigma is essential for effective identification (Toney-Butler et al., 2017).
Policy
Several key policies have been enacted to address human trafficking at both the national and international levels, creating tools for both law enforcement and victim support services.
The Trafficking Victims Protection Act (TVPA) of 2000 was a landmark piece of federal legislation. It allows trafficked foreign nationals to be eligible for federally funded benefits, including healthcare and immigration assistance.
The T Visa is a specific provision that offers immigration relief to victims of human trafficking. It prohibits deportation and provides a pathway to potential permanent residency, which encourages victims to come forward and cooperate with law enforcement without fear of being removed from the country.
The United Nations Sustainable Development Goals also address this issue, with Goal 8 aiming to promote "decent work and economic growth," directly targeting the exploitative labor conditions that trafficking creates.
Scope of Trafficking
Human trafficking, including domestic servitude, occurs in every region of the world. However, measuring its true prevalence is difficult due to the hidden nature of the crime.
Global Estimates: The estimated number of people in modern slavery varies widely, with figures ranging from 12.3 million to over 45.8 million worldwide. This vast range reflects the significant challenges in data collection.
Types of Trafficking: According to the United Nations Office on Drugs and Crime, sex trafficking accounts for approximately 50% of all trafficking cases. The International Labour Organization provides a more conservative estimate of 23%.
Victim Demographics: Children constitute a large portion of victims, making up around 46% of cases. In high-income countries, child trafficking is often for sexual exploitation, forced criminality, or begging, whereas globally it is more often for forced labor (Trafficking, n.d.). Traffickers disproportionately target the extremely poor, those from dysfunctional homes, and individuals who have been abandoned. Approximately 61% of all victims are women and girls.
Runaways: In the U.S., the link between running away and trafficking is strong. The National Center for Missing and Exploited Children estimates that one in six endangered runaways is likely a victim of child sex trafficking.
Trafficker Profiles: Trafficking is not typically perpetrated by lone individuals. The majority of cases (57%) are run by organized criminal enterprises. Other structures include "governance-type" organized crime (18%), opportunistic associations (14%), and individual traffickers (11%). This highlights that trafficking is often a business, and identifying one victim may lead to a much larger network.
National Prevalence
In the United States, several organizations work to track the scope of the problem, providing the best available data on this clandestine activity.
The Polaris Project: This is a leading research and advocacy organization that has handled over 400,000 contacts related to trafficking since its inception.
National Human Trafficking Hotline: In 2023 alone, the hotline received over 30,000 "signals"—including calls, texts, emails, and web chats. These signals led to the identification of over 9,600 potential cases involving nearly 17,000 victims.
Michigan Data: In 2023, Michigan accounted for 779 of these tips, which resulted in 254 confirmed cases and 506 victims. The running total of data for Michigan reflects nearly 10,000 tips, over 3,000 confirmed cases, and more than 6,200 victims since the hotline began collecting data.
Across the U.S., victims of both sex and child trafficking are disproportionately women and girls, with women and girls of color being impacted at even higher rates.
Data Limitations
Despite these numbers, there are major gaps in the research on trafficking prevalence and identification (Barrick & Pfeffer, 2024). The data we have likely represents only a fraction of the true scope of the problem.
Key limitations include:
Hidden Population: Trafficking is a clandestine crime. Victims are difficult to reach and may not self-identify, making accurate counts nearly impossible (Barrick & Pfeffer, 2024).
Varied Definitions: Different agencies and jurisdictions may use slightly different definitions of trafficking, leading to inconsistencies in data collection.
Multiple Data Sources: Data is collected by various entities, including social services, healthcare systems, and the criminal justice system, but these sources are often not integrated.
Difficulty of Proof: Proving trafficking, especially when it involves psychological manipulation rather than physical confinement, is much harder than proving other crimes. This leads to a significant drop-off between potential cases and official prosecutions. For instance, of 11,500 potential situations identified by the National Human Trafficking Hotline in 2019, federal law enforcement opened only 1,830 cases (U.S. Department of State, 2020).
Social Factors
Certain social factors create and exacerbate the vulnerabilities that traffickers exploit. These factors often relate to instability and a lack of a protective social network.
Unstable or Insecure Housing: Individuals who are homeless or at risk of homelessness are prime targets. This includes youth aging out of the foster care system, who often lack the support services needed to transition to stable independence.
Displacement: Displaced populations, such as undocumented migrant workers and refugees, are particularly vulnerable. Language barriers can prevent them from understanding the true nature of a fraudulent offer, and the fear of deportation is a powerful tool of coercion.
Minority or Disability Status: Individuals belonging to minority groups or those with disabilities often face discrimination and marginalization, which increases their risk.
Poverty and Marginalization: Poverty creates a desperation that traffickers prey on. When people lack access to basic resources, a false promise of a job or a safe home can be incredibly alluring.
These vulnerable populations are disproportionately impacted because their life circumstances align perfectly with the manipulative tactics used by traffickers.
Systemic Contributors
Beyond individual social factors, broader systemic issues within a society contribute to an environment where trafficking can thrive. These are large-scale problems that increase risk for entire communities.
Systemic contributors include:
Lack of access to quality healthcare
Inadequate educational opportunities
Limited access to stable, living-wage employment
Shortages of safe, affordable housing
Harmful cultural norms and attitudes around sex, gender, and labor
These systemic failures create a constant state of precarity for many people, making them more susceptible to the false promises of exploiters.
Previous Trauma as a Risk Factor
A history of trauma is one of the most significant risk factors for becoming a victim of human trafficking. Traffickers specifically target individuals who have already been victimized, as they are often more easily manipulated and controlled.
Key trauma-related risk factors include:
Adverse Childhood Experiences (ACEs): A high ACE score, which measures experiences like abuse, neglect, and household dysfunction before the age of 17, is strongly correlated with a wide range of negative life outcomes, including vulnerability to trafficking (De Vries & Goggin, 2020).
Neglect from Caretakers: A history of neglect can leave individuals with a profound need for safety and affection, which traffickers exploit through "loverboy" tactics of feigned love and security.
Intimate Partner Violence (IPV) and Sexual Abuse: Prior experiences with IPV or sexual abuse can normalize exploitation and make it harder for a victim to recognize and resist a trafficking situation.
Gender Identity: Transgender individuals face high rates of discrimination, family rejection, and homelessness, leading to increased vulnerability. According to a 2015 survey by the National Center for Transgender Equality, 1 in 25 transgender individuals had engaged in sex work, and 19% had participated in "survival sex" to meet basic needs.
In Hospitals
Healthcare settings are a critical, and often missed, opportunity for intervention. Research indicates that as many as 87% of trafficking victims in captivity seek medical treatment at some point during their exploitation but do not receive assistance (Toney-Butler et al., 2017).
Healthcare professionals should be aware of the following dynamics:
Use of Translators: If a translator is needed for a suspected victim, it should never be a family member or the person who accompanied them to the appointment. This person could be the trafficker. An independent, professional interpreter is essential (Hachey & Phillippi, 2017).
Trafficker Behavior: Traffickers often seek the fastest possible care to minimize exposure. They may become aggressive or agitated over long wait times in an emergency department and may "hospital shop" to get in and out quickly.
Victims from All Backgrounds: While it is important to be aware of risk factors, professionals must remember that victims can come from any social group or economic background. A person who appears to come from a stable home can still be a victim.
In Child Welfare & Juvenile Justice Systems
The child welfare and juvenile justice systems are high-risk environments for trafficking. Youth in these systems are often dealing with the exact vulnerabilities—such as a history of trauma, instability, and lack of a protective family—that traffickers seek out.
Although research in this area is limited, existing studies show a strong overlap. A study in Florida of over 12,000 allegations found that half of the children with a human trafficking abuse allegation were already involved in the child welfare system at the time (Scaggs et al., 2024).
Further findings from this study include:
Females were more likely than males to be involved in the child welfare system.
Black children were more likely than white children to be involved in both the child welfare and juvenile justice systems.
Victims of sex trafficking were more likely than victims of labor trafficking to be involved in both systems (Scaggs et al., 2024).
This data underscores the need for professionals in these systems to shift their perspective. An adolescent who appears to be a "perpetrator" of a crime may, in fact, be a victim of trafficking. Adopting a mindset that views these youth as potential victims first is crucial for breaking the cycle of exploitation.
Signs of Human Trafficking
Recognizing the signs of human trafficking requires a multi-faceted approach that looks at physical, behavioral, and psychological indicators. It is also important to understand the common venues where trafficking occurs and the characteristics of potential victims. However, it is essential to remember that many victims may fall outside of a typical profile (Rambhatla et al., 2021).
Physical Indicators
Physical signs are often the most direct evidence of abuse, though they are not always present.
Injuries and Neglect: Look for unexplained injuries, signs of physical abuse or neglect, poor hygiene, and signs of malnutrition or dehydration (Rambhatla et al., 2021).
Specific Wounds: Certain types of injuries are highly suggestive of trafficking, such as abrasions from ropes or belts, scratches, road rash, and small, circular cigarette burns.
Branding and Tattoos: Research has shown that brandings, tattoos (especially those indicating ownership), and rashes are more common in sex trafficking. In contrast, victims of labor trafficking are more likely to present with burns and deep cuts related to hazardous working conditions (Rambhatla et al., 2021).
Behavioral Indicators
Behavioral indicators often reflect the fear and control that define a victim's experience.
Demeanor: A victim may appear fearful, anxious, submissive, or hyper-vigilant.
Reluctance to Share Information: Evasiveness or reluctance to share personal information is a major red flag.
Detachment: The person may speak about their experiences in the third person, a form of mind-body separation common in trauma survivors.
Physical State: They may appear sleep-deprived or impaired by substances.
Inconsistent Stories: Pay close attention to inconsistencies in their stories about their home life, job, or relationships.
Unexplained Absences: For minors, this can manifest as unexplained absences from school, poor attendance, or runaway behavior.
Pride in Travel: Paradoxically, a young person might boast about travel, which could be a red flag if the details are vague or do not add up.
Psychological Indicators
The psychological toll of trafficking is immense and often presents with symptoms that overlap with other mental health conditions.
Trauma Symptoms: Victims frequently exhibit symptoms of Post-Traumatic Stress Disorder (PTSD), such as nightmares, flashbacks, irrational fears, and irritability (Hopper & Gonzalez, 2018; Okech et al., 2018).
Mood and Anxiety Disorders: Depression and anxiety are extremely common (Hopper & Gonzalez, 2018).
Other Conditions: Substance abuse and suicidal ideation are also prevalent among survivors (Sidun, 2025).
Trauma Bonding: Victims may show a strong, seemingly loyal attachment to a controlling or abusive individual. This phenomenon, known as trauma bonding, is a survival mechanism that can be mistaken for a consensual relationship.
Social Isolation: Traffickers work to isolate their victims from friends and family to maintain control. This isolation becomes a significant psychological indicator (Okech et al., 2018).
Identifying Venues
Trafficking can happen anywhere, but certain venues and industries are known hotspots for recruitment and exploitation.
Online and Youth-Centered Venues: Recruitment often happens online through social media and chat rooms. After-school programs can also be venues, with traffickers sometimes being other students.
Advertisements: Job advertisements may contain red flags, such as obscured phone numbers, language over-emphasizing trustworthiness ("this is a safe job"), or specifications about ethnicity or youth.
High-Risk Activities: Activities such as stripping, pornography, forced begging, and drug sales are often linked to or serve as entry points into trafficking.
Common Labor Venues: Labor trafficking is common in restaurants, hair and nail salons, domestic work (as nannies or au pairs), and agricultural settings.
Common Sex Trafficking Venues: Sex trafficking frequently occurs in hotels and motels, on the street, in brothels (which may be disguised as homes or legitimate businesses), through escort services, and at truck stops, bars, and strip clubs.
Clinical Red Flags
In a clinical setting, several red flags can indicate that a patient may be a victim of trafficking.
Controlling Companion: The person is accompanied by a dominant individual who speaks for them, refuses to let them be alone, or becomes agitated when the patient is addressed directly.
Lack of Documents: The patient lacks identification documents, such as a driver's license or passport, or is not in control of them.
Inability to Keep Appointments: They are unable to schedule or attend appointments independently.
Signs of Control: There are signs that the person is working excessively long hours, is being constantly monitored, or has their movements restricted.
Health Indicators: Recurrent sexually transmitted infections (STIs), especially in a minor, are a major red flag. Other signs can include signs of addiction and injuries that the patient claims are self-inflicted (Hachey & Phillippi, 2017).
Questions to Ask: Identifying Trafficking Red Flags
Because victims may be afraid to disclose their situation directly, asking indirect questions can help gather information and identify red flags. These questions should be asked in a private, safe setting without anyone else present.
Work and Finances
Are you being paid the wages that were part of the initial agreement?
Can you change jobs if you want to? Would anything happen to you if you quit your job?
Did you pay a fee to get your job? Do you owe a debt to your employer?
Do you have access to your money and your identification?
Freedom of Movement
Can you come and go as you please, take bathroom breaks, and eat when you want?
Have you moved around a lot? Do you know your current address?
Are there locks on the doors or bars on the windows where you live? Can you leave freely?
Living and Working Conditions
What are your home conditions like? Do you have your own bed?
Is it too cold or too hot where you live or work?
Are you provided with safety equipment for your job, like masks, gloves, or a safety harness?
Does your employer provide your housing?
Safety and Threats
Has your employer or anyone else ever threatened you?
Are you concerned about your safety? What about your family's safety?
(Adapted from the National Human Trafficking Resource Center)
Trauma-Informed Care
A trauma-informed care approach is essential when working with potential victims of trafficking. This approach is designed to create an environment of safety and trust and to minimize the risk of re-traumatization.
Key principles include:
Recognize Trauma Signs: Be aware of the signs of trauma, including nonverbal cues, and make appropriate referrals.
Create a Safe Environment: Use slow, calm speech, maintain respectful eye contact, and position oneself at the same physical level as the client. The physical layout of the room, including the location of the door, should be considered to enhance feelings of safety.
Empower the Client: The goal is to restore a sense of power and control to the client. Allow them to make choices and lead the conversation where possible. Avoid creating a dynamic where the professional is an authority figure to be feared. It is not enough to say "this is a safe space"; the professional must earn that trust through their actions.
Communicating
The language used with a potential victim is critical for building trust. Communication should be supportive, non-judgmental, and clear.
Here are some suggested phrases:
"We are here to help you, and our priority is your safety. We can help keep you safe."
"Everyone has the right to live without being abused or hurt, and that includes you."
"You deserve to be independent and make your own choices. We can help you with that."
"We can get you help to protect your family and your children."
"You have rights, and I will do everything in my power to help you."
"You can decide what is best for you, but let me give you a number you can call for help 24 hours a day. You don’t even have to tell them your name."
Crucially, do not make false promises. Only offer assistance that can realistically be provided. Offering help and failing to deliver can be deeply re-traumatizing.
(Adapted from the Department of Health and Human Services)
Cultural Competency
Cultural competency is the ability to work effectively with diverse populations. In the context of human trafficking, it involves understanding how cultural factors can influence a victim's experience and disclosure.
Avoid Assumptions: Do not write off potential signs of trafficking as mere "cultural differences."
Recognize Language Barriers: Language barriers can obscure discrepancies in a person's story, causing professionals to miss red flags. As stated previously, always use a professional, independent interpreter.
Understand Cultural Stigma: A victim's immigration status or cultural stigmas around sex and abuse can be powerful barriers to disclosure.
Examine Personal Biases: All professionals have biases. It is critical to reflect on these biases and prevent them from interfering with identification and care. For example, a bias that a person "should have known better" can completely shut down a provider's ability to see the coercion involved.
Barriers to Identification
Several factors can prevent the successful identification of trafficking victims.
Lack of Protocols or Resources: Many organizations lack clear protocols for how to respond to a suspected case of trafficking.
Stigma, Myths, and Stereotypes: Preconceived notions about what trafficking is and who it affects can blind professionals to the reality in front of them (e.g., the myth that it only happens in other countries).
Lack of Privacy: It can be difficult to separate a potential victim from their trafficker, both physically and psychologically, due to the strong trauma bond that may exist.
Incomplete History: A client may not give a full or accurate history, making it impossible to identify them as a victim.
Clinical Applications
To apply this knowledge in a clinical setting, professionals should focus on several key actions:
Establish Trust: Work actively to identify potential victims by establishing trust and consistently practicing trauma-informed care.
Know Local Resources: Become familiar with the National Human Trafficking Hotline as well as local shelters, advocacy groups, and other support services. Being able to provide a direct, local referral can make all the difference.
Understand Reporting Laws: Learn the specifics of the mandatory reporting laws in the applicable state or jurisdiction.
Pursue Further Education: Take advantage of further training opportunities, such as simulations or role-playing exercises, to build skills and confidence in identifying and responding to trafficking.
Head-to-Toe Assessment, 1
A systematic physical assessment can reveal numerous indicators of human trafficking. The following is a comprehensive guide to potential findings from a head-to-toe evaluation.
Head/Face: Look for bruising (old, new, or healing), lacerations, hematomas, and signs of acute or chronic head trauma or headache. Check for missing hair or bald spots from hair-pulling.
Ears/Mouth: Assess for hearing trouble, damage to the auditory canal or eardrum, and trauma to the oropharynx (e.g., lacerations, burns, ulcerations). Note any broken teeth, tooth decay, or gum irritation. The oral mucosa can also show signs of anemia or dehydration.
Eyes/Neck: Note any visual defects, tattoos or brands hidden in the hairline or on the neck, and any signs of strangulation, such as bruising.
Chest/Cardiovascular: Check for signs of chest trauma, heart murmurs, cigarette burns, and tattoos that imply ownership. Be aware of stress-related cardiovascular issues like arrhythmias or high blood pressure.
Respiratory/Environmental: Inhalation injuries may be present from exposure to chemicals, toxic fumes, asbestos, or mold. Meth lab exposure can cause burning to the eyes, nose, and mouth, chest pain, and dizziness. Look for signs of tuberculosis (night sweats, coughing up blood, fever, weight loss) or signs of hypothermia/hyperthermia from poor working conditions.
Gastrointestinal: Assess for chronic GI issues like nausea, vomiting, or abdominal pain. Check for rectal trauma, bleeding, or parasites.
Head-to-Toe Assessment, 2
The assessment should continue through the rest of the body systems, paying close attention to signs of sexual and physical abuse.
Back/Genitourinary: Look for bruising or scarring on the back. Sexually explicit tattoos or tattoos implying advertisement in the pubic area are a major red flag.
Obstetrical/Gynecological: Note any OB/GYN complaints, especially recurrent STIs. An STI in a minor is a powerful indicator of sexual abuse. Other signs include repeated unwanted pregnancies, forced abortions, anogenital trauma, and evidence of retained foreign bodies in the vagina. Inquire about the number of sexual partners and condom use.
Musculoskeletal: Look for signs of repetitive trauma, work-related injuries, or injuries from forced acts (e.g., back problems from wearing heels for long hours, jaw problems from forced oral sex). Note any fractures (old or new) and contractures.
Extremities/Skin: Check for cigarette or scald burns. Ligature marks or scars around the wrists and ankles are highly indicative of bondage. Look for skin conditions like scabies, infestations, impetigo, or fungal infections.
Nutritional: Signs of nutritional deficits can include Vitamin D deficiency (from lack of sunlight), anemia, fine or brittle hair, signs of anorexia or bulimia, and severe electrolyte abnormalities. In children, look for growth abnormalities and poor dental health.
Neurological: Neurological issues can include unexplained memory loss, inability to concentrate, migraines, vertigo, numbness or tingling, and seizures or pseudo-seizures. Insomnia and nightmares are also common.
Key Resource: National Human Trafficking Hotline
The single most important resource for professionals and victims is the National Human Trafficking Hotline.
Phone: Call 1-888-373-7888.
Text: Text "HELP" to 233733.
Emergency: Call 911 for immediate danger.
Live Chat: humantraffickinghotline.org
Email: help@humantraffickinghotline.org
This confidential service does more than take tips. It connects victims and survivors to services in their local area and provides training and technical assistance to professionals. Support is available in English, Spanish, and over 200 other languages through interpreters.
Take-Home Messages
Human trafficking is a complex issue, but awareness and diligence can save lives.
Be aware of the upstream social factors and community characteristics that make certain groups more susceptible to exploitation.
Remember that trafficking affects people from all walks of life; do not let stereotypes prevent identification.
Identification can happen before or during confinement. Recognizing early warning signs is a key part of prevention.
Do not be afraid to ask direct, non-judgmental questions in a safe and private setting.
Understand that many victims may not have the capacity or willingness to leave their situation immediately due to intense psychological manipulation and fear. Be patient and persistent in offering support.
References
Barrick, K., & Pfeffer, R. (2024). Advances in measurement: A scoping review of prior human trafficking prevalence studies and recommendations for future research. Journal of Human Trafficking, 10(1), 1–19.
Eryarsoy, E., Topuz, K., & Demiroglu, C. (2024). Disentangling human trafficking types and the identification of pathways to forced labor and sex: An explainable analytics approach. Annals of Operations Research, 335(2), 761–795.
Hopper, E. K., & Gonzalez, L. D. (2018). A comparison of psychological symptoms in survivors of sex and labor trafficking. Behavioral Medicine, 44(3), 177–188.
Okech, D., Hansen, N., Howard, W., Anarfi, J. K., & Burns, A. C. (2018). Social support, dysfunctional coping, and community reintegration as predictors of PTSD among human trafficking survivors. Behavioral Medicine, 44(3), 209–218.
Rambhatla, R., Jamgochian, M., Ricco, C., Shah, R., Ghani, H., Silence, C., ... & Kourosh, A. S. (2021). Identification of skin signs in human-trafficking survivors. International Journal of Women’s Dermatology, 7(5), 677–682.
Scaggs, S. J., Starseed, S. C., Kluckman, M., Tueller, S., & Yu, L. (2024). A state-wide analysis of characteristics and predictors of dual system involvement among child victims of human trafficking. Child Abuse & Neglect, 147, 106530.
Sidun, N. M. (2025). Understanding and combating human trafficking: A psychological perspective. American Psychologist.
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Citation
Nathenson, S. (2025). Protecting Vulnerable Populations: Human Trafficking Identification for Health Professionals. Continued Psychology, Article 113. www.continued.com/psychology
