Back Clinic Protective Services. The Texas Department of Family and Protective Services (DFPS) works with communities to protect children, the elderly, and people with disabilities from abuse, neglect, and exploitation. It also works to protect the health and safety of children in daycare, as well as foster care and other types of 24-hour care. We do this through investigations, services and referrals, regulation, and prevention programs.
DFPS has five major programs that do this important work:
Manages community-based programs that prevent juvenile delinquency and child abuse and neglect.
Please call the Texas Abuse Hotline if you suspect that a child or adult who is elderly or has disabilities is being abused, neglected, or exploited. For answers to any questions you may have please call Doctor Alex Jimenez at 915-850-0900
Can healthcare professionals implement H.E.A.R.T. protocols for trafficked individuals while providing a safe space?
Introduction
Across the world, many local media and organizations are paying close attention to a phenomenon that many people should be aware of. This phenomenon is known as trafficking, and it can be associated with numerous activities, from forced labor to sex labor, and can affect a person’s sense of self-worth. While many people will correlate that trafficking affects many women and children, it can affect many individuals regardless of age, gender, and background. While many survivors of trafficking are dealing with the psychological and physical injuries that they obtain from their traffickers, many medical professionals can implement protocols and roles through the implementation of H.E.A.R.T. to provide a safe space for individuals suffering from trafficking. Today’s article focuses on the definition of trafficking, what H.E.A.R.T. is, and how it is used in a clinical setting. We discuss with certified associated medical providers who consolidate our patients’ information to assess and identify trafficking in a clinical approach while providing a safe space. We also inform and guide patients while asking their associated medical provider intricate questions to formulate customized treatment plans for their pain and provide them with a safe space and positive experience. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.
The Definition Of Trafficking
When it comes to defining trafficking, it can be challenging as it is frequently associated with other issues. However, the main definition for trafficking is “recruiting, transporting, transferring, or harboring many individuals or a person that are threatened or forced to achieve the consent of a person having control of the individuals for exploitation.” With human trafficking being a pressing public concern that affects all races, social classes, demographics, and genders, it can impact society and the individual who is being trafficked. (Toney-Butler et al., 2024) Additionally, many people often mistake trafficking and smuggling as they are completely different. Smuggling requires a person to be transported into a nation through voluntary illicit means. While trafficking can come in two forms, which are labor and commercial sex, it can happen within the person’s own home. (Rambhatla et al., 2021) This is because many survivors who are going to get healthcare services will feel various emotions of fear or shame that can prevent them from asking for help due to what they have been through with their trafficker. However, when many individuals who are trafficking survivors are suffering from significant physical, mental, and social health problems and are seeking healthcare services, many healthcare professionals play an important role by creating a safe and responsive space for them. (The Lancet Regional Health-Western, 2022)
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What is H.E.A.R.T In A Clinical Setting
When it comes to creating a safe and positive space in a clinical setting, many healthcare professionals often miss the signs of trafficking due to a lack of training or confidence to identify and treat patients who are trafficking victims. (Lee et al., 2021) However, healthcare protocols should be implemented, and H.E.A.R.T. should be incorporated into a clinical approach to assess and develop a customized treatment plan for the patient. Healthcare professionals can engage with the patient in a one-on-one discussion away from their trafficker and can offer important medical and psychological care resources. (Exeni McAmis et al., 2022) By incorporating H.E.A.R.T. protocols in a healthcare clinic, many doctors and medical professionals can help many patients be in a safe environment. Below is what H.E.A.R.T. stands for.
H-Hearing
The “H” in H.E.A.R.T. is for hearing as many medical professionals not only to hear but to see what is going on in the clinic and to establish environmental awareness. This is due to looking at the patient and who is accompanied by them. With healthcare providers being at the front, they interact with patients and may not know what health concerns are affecting them. This could be due to the following:
By incorporating the hearing aspect in H.E.A.R.T., many healthcare professionals can provide a safe, thoughtful, and engaging approach to the patient and know what to look for when a patient is coming in for treatment.
E-Evaluating
The “E“ in H.E.A.R.T. is used to evaluate its importance in enhancing patient interactions in a trauma-informed care facility. This is highly important because the individual is seeking health care. For the patients being trafficked, it is important to notice the red flags the individual is experiencing. Some of the red flags that many healthcare providers should look for are:
Physical health
Behavioral Health
The patient is with a controlling person
The patient does not have possession of their I.D.
Additionally, it is always important to show compassion, be sensitive to the individual while addressing their needs and concerns, and use a non-judgmental approach during the interview process. This helps the individual ensure they are in a safe environment when discussing sensitive topics. At the same time, it is important not to let the patient be re-traumatized while avoiding the impulse to rescue and overpromise the patient to mental health as we want them to have their self-worth. At the same time, it is best to remember the four “Rs“ when doing a trauma-informed approach; they are:
Realize: Understanding how trauma can affect people.
Recognize: Recognizing the signs of trauma.
Respond: Have all staff trained, use evidence-based practices, and provide a safe environment.
Resist Re-trauma: Recognizing how some practices may trigger painful memories while avoiding re-traumatizing the patient.
By implementing the four “Rs“ and the “E“ in H.E.A.R.T., many healthcare professionals can provide valuable resources to trafficking survivors with a strong support system.
A-Activating
The “A“ in H.E.A.R.T. stands for activating, where healthcare professionals must have proper protocols to engage all employees. This allows the healthcare providers to understand how beneficial it is to develop a protocol for a person who is being trafficked, understand their state and federal reporting laws, and list key elements of effective trauma-informed screening procedures when assessing the patient. This allows a foundational structure to support a response for suspected patients who are being trafficked. At the same time, by following HIPAA laws and organization policies, many healthcare providers must explain the reporting process to the right officials. Additionally, the benefits of developing a protocol for trafficking are by:
Clarifying procedures
Enhance staff training
Optimize the interactions with the trafficking patients
Improve staff confidence
Prepare for any threatening situations
Maximizing preparedness to aid trafficking patients
Optimize support for patients
Develop collaborative outside resources
R-Resourcing
The “R“ in H.E.A.R.T. stands for resourcing, as many healthcare providers must identify the referral systems. This allows healthcare professionals to understand the important message to convey when assessing trafficking victims and the importance of responding to safety, emergency, and reporting requirements. When assessing and interviewing the patient, many will have to recognize that their patient may be a possible victim of trafficking, what their immediate needs are, and what long-term resources can help.
T-Training
The “T” in H.E.A.R.T. stands for training, as it is important that many healthcare providers continuously train to spot trafficking; this provides confidence to many healthcare workers and can help save a person’s life. By implementing H.E.A.R.T. protocols, the “T” allows the doctor to respect the individual’s decision to want help, providing a positive support system while encouraging them to come back, offering to help with a safety plan, and building a resource network. This is because if the patient is accompanied by someone who is controlling and answering for the patient, handing out information discreetly can provide a bit of hope to the individual to make the move. At the same time, providing local and immediate assistance resources can help the individual in the long run. This allows healthcare providers to build a trusting relationship and even help individuals to have a safe and positive experience on their health and wellness journey.
References
Exeni McAmis, N. E., Mirabella, A. C., McCarthy, E. M., Cama, C. A., Fogarasi, M. C., Thomas, L. A., Feinn, R. S., & Rivera-Godreau, I. (2022). Assessing healthcare provider knowledge of human trafficking. PLOS ONE, 17(3), e0264338. doi.org/10.1371/journal.pone.0264338
Gutfraind, A., Yagci Sokat, K., Muscioni, G., Alahmadi, S., Hudlow, J., Hershow, R., & Norgeot, B. (2023). Victims of human trafficking and exploitation in the healthcare system: a retrospective study using a large multi-state dataset and ICD-10 codes. Front Public Health, 11, 1243413. doi.org/10.3389/fpubh.2023.1243413
Lee, H., Geynisman-Tan, J., Hofer, S., Anderson, E., Caravan, S., & Titchen, K. (2021). The Impact of Human Trafficking Training on Healthcare Professionals’ Knowledge and Attitudes. J Med Educ Curric Dev, 8, 23821205211016523. doi.org/10.1177/23821205211016523
Rambhatla, R., Jamgochian, M., Ricco, C., Shah, R., Ghani, H., Silence, C., Rao, B., & Kourosh, A. S. (2021). Identification of skin signs in human-trafficking survivors. Int J Womens Dermatol, 7(5Part B), 677-682. doi.org/10.1016/j.ijwd.2021.09.011
The Lancet Regional Health-Western, P. (2022). Human trafficking is more than a crime. Lancet Reg Health West Pac, 20, 100444. doi.org/10.1016/j.lanwpc.2022.100444
Domestic abuse: October is a�Domestic Violence Awareness Month, so it�is time to get a closer look at this increasing form of violent behavior. By and large, the general public is unaware of the effects domestic abuse has on its victims, other family members and society as a whole. Therefore, attempts are being made to heighten society�s awareness of the many facets of this violent crime that plagues America today.
Because people should be aware of the types of abuse crimes that fall into the category of domestic abuse, and who the victims of domestic abuse are, the center is answering questions, such as �Does one have to be a spouse or other immediate family member to be considered a victim of domestic abuse?�
WHAT IS DOMESTIC ABUSE?
This is a crime that involves abuse of family members, romantic partners, and others. The crimes of domestic abuse are numerous, ranging from verbal abuse to murder. They include emotional abuse, such as intimidation and threats, assault, battery (with or without the use of a deadly weapon), sexual abuse (i.e. spousal rape), kidnapping, and detaining one against his or her will.
When considering crimes of domestic abuse, most states consider certain relationships to be �domestic relationships.� In these states, the relationships usually include spouses, former spouses, persons who share a common child together, persons currently residing together or those that have previously shared a domestic living arrangement together, in their criteria for domestic relationships.
DOMESTIC VIOLENCE TODAY
The problem of Domestic violence is on the rise and becoming ever more dangerous to its victims who live in fear. However, the average person in the United States today is unaware of just how serious and out of hand the crime of domestic violence is becoming. This could possibly be because many Americans do not live with conflict and violence in their homes.
Conversely, many victims of domestic violence do not even realize that they are victims of the crime of domestic violence. They�ve been misled by their abusers and believe that the abuse they are victimized by, really is not abuse at all, but just �a way of life.�
In February, an immigration enforcement case in El Paso earned the attention of domestic violence advocates across the country. As the El Paso Times reported, an undocumented woman was detained by immigration officers right after she went to the courthouse to get a restraining order against a violent and abusive partner. Domestic violence advocates were horrified, worried that it would potentially deter undocumented people from reporting abuse to law enforcement. “It sends a powerful message to victims and survivors that there is no safe place,” Ruth Glenn, executive director of the National Coalition Against Domestic Violence, told Bustle in February.
Now, a month later, the effect of fighting domestic violence is being felt. Sometime after the El Paso incident, Enrique Elizondo, a worker for a domestic violence hotline, received a call from an undocumented woman (I have not included any identifying details to protect her confidentiality), facing an abusive husband. According to Elizondo, she was at the point of fear that the abuse could become lethal. But, after selling all her belongings to come to the United States, she found herself feeling like she was out of options. According to Elizondo, her partner had specifically made threats about contacting Immigration and Customs Enforcement (ICE) and having her deported if she took action. The El Paso case made her fear he could. Elizondo tells Bustle he tried to help her contact legal help, but the woman asked him, Is this legal advocate going to deport me? Ultimately, Elizondo says he was able to get her legal help.
Supporting All Survivors on International Womens Day
As we celebrate International Women’s Day, it’s important to remember that ALL women deserve support and safety, regardless of race, religion, country of…
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According to domestic violence advocates interviewed for this article, these situations are becoming the norm for dealing with undocumented survivors of domestic violence. The 2013 re-authorization of the Violence Against Women Act (VAWA) protects survivors of abuse from deportation for reporting the crime, but, as fear in undocumented communities has grown due to more expansive calls for immigration enforcement under Donald Trump’s administration, it’s hard for the people helping survivors to convince them they’re safe.
The February El Paso case may very well have been a fluke according to the El Paso Times, the woman detained had further criminal complaints against her beyond her immigration status. But the publicity generated by a women detained while seeking help from a court has nevertheless led to worry among violence survivors. Already, four cases in Denver of domestic violence were dropped due to fears of the survivors about immigration status, according to Denver City Attorney Kristin Bronsonm who spoke to NPR about the situation.
“That case [in El Paso] alone, I am actually sure had a chilling effect,” Ruth Glenn tells Bustle a month after we initially spoke. Her organization, the National Coalition Against Violence, is working “to ensure that advocates know how to support those victims by making sure that they know what the laws and the rules are,” she says. Specifically, it has been focusing on helping shelters figure out how to deal with these issues such as knowing that they are expected to maintain the confidentiality of their residents even if ICE officers shows up at the door.
Unfortunately, some are prioritizing continuing to live with abuse.
Under the Obama administration, a 2011 legal memorandum required ICE to exercise prosecutorial discretion when dealing with victims or witnesses to crimes like domestic violence.
According to a statement from Letitia Zamarippa, spokeswoman for ICE, that memo is still in effect. U.S. Immigration and Customs Enforcement (ICE) officers will take into consideration if an individual is the immediate victim or witness to a crime, in determining whether to take enforcement action. Particular attention is paid to victims of domestic violence, human trafficking or other serious crimes.”
But even with the law officially in place, the uncertainty caused by Trump administration actions stepping up deportations and limiting restrictions on ICE causes fear among survivors.
The Trump administration’s recent actions taking aim at sanctuary cities, hoping to push local police agencies to enforce immigration laws, worries advocates, as well.
If you think about victims of domestic violence who are already being controlled by a perpetrator, that is compounded and exacerbated when you rely on that person to interpret the laws for you, who is filtering all that information to control you.”
“When you have your local sheriff, whose job is to come to domestic violence scenes and to be in the community if they’re also enforcing immigration law the question is whether victims are going to come call when they’re being abused or sexually assaulted,” says Huang. “Entire communities are afraid of reaching out for help. ICE officers are not always the best at finding out if there’s victims.”
Overall, the growing sense of uncertainty, the anti-immigration rhetoric, and the threats to sanctuary city are leaving a strong impact on domestic violence victims who live in a legal gray area and may not be well versed in their legal rights. “If you think about victims of domestic violence who are already being controlled by a perpetrator, that is compounded and exacerbated when you rely on that person to interpret the laws for you, who is filtering all that information to control you,” Monica McLaughlin, Deputy Director of Public Policy at the National Network to End Domestic Violence, tells Bustle.
The underlying problem is that even if undocumented immigrants can technically get help, McLaughlin explains, “if what’s been communicated indicates that they can’t because they’re not safe, then survivors really aren’t going to reach out to law enforcement for help.”
One of the most troubling concerns facing our community is domestic violence. In Texas, 1 in 3 adult women has been a victim of domestic violence. Over the past year and a half, the Corpus Christi Caller-Times has done an excellent job of putting domestic violence at the forefront by covering its effects and exploring solutions to reduce the deadly trend. These stories and statistics should motivate all of us to work to better protect victims.
Since the 1980s, the prevention of domestic violence in Texas has been a top priority and much of my legislation supports programs that aim to overcome domestic violence. When I was chairman of the House Criminal Jurisprudence Committee, we held public hearings that discussed the serious problem of women serving prison time for defending themselves against a violent partner. As a result, several members carried legislation to change the laws to help protect victims of family violence.
In 2009, committee Chairman Abel Herrero and I authored Mary’s Law, which allows for GPS monitoring of domestic violence offenders. And most recently, in 2015, I sponsored House Bill 2645, which allows juries to hear more information about family violence and increases accountability for offenders monitored by GPS as part of a protective order. This bill now allows law enforcement to arrest the violator in real time for a violation of a protective order, thereby increasing victim safety and offender accountability.
Funding to help prevent family violence is critical. As vice chairman of the Senate Committee on Finance, I secured a $1 million increase in funding for the Battery Intervention Prevention Program, in which offenders are held accountable for past abusive behavior and taught the fundamentals of leading healthy, nonviolent relationships. The increase in funds allows services to expand and adds innovative approaches to current practice. Additionally, the 2016-2017 budget included $53.9 million for core services provided by family violence programs and $3 million to address unmet needs such as housing and childcare. We will continue to work with advocates to address funding shortfalls for organizations that provide assistance to victims and offenders.
While the Texas Legislature has strengthened laws against abusers to give district attorneys and our communities more tools to protect family violence victims and provide funds for family violence programs, much work remains to be done. In order to end the cycle of violence, our community needs to focus on prevention by raising public awareness while also effectively implementing and enforcing laws.
Implementation is key to protecting victims. It was alarming to learn that the family violence center in our community was closed on weekends. However, through the Coastal Bend Community Coordinated Response Coalition forums, victims and advocates called for change. As a result, Corpus Christi Police Chief Mike Markle implemented changes so that family violence detectives are rotated for weekends and after-hours duty. This is a step in the right direction so that victims of abuse do not live in fear simply because it is a weekend.
One solution to addressing domestic violence is to adopt components from the city of El Paso’s 24-Hour Contact Domestic Violence Initiative. The program takes a proactive and aggressive approach by moving domestic violence cases through the criminal justice system more effectively and focuses on victim outreach. Victim advocates seek face-to-face contact with victims of a domestic violence crimes for which an offender has been arrested within the past 24 hours. We need to collaborate among relevant agencies and discuss how we can improve and adopt El Paso’s model.
It will take more than one person, one agency, or one government entity to curb domestic violence. It will take work from legislators, law enforcement, the probation department, our local family violence shelter, public officials, parents, students and residents throughout our community to ensure we protect victims and hold their abusers accountable. Together, and only together, can we make our community a safer place.
Dr. Alex Jimenez D.C.,C.C.S.T’s insight:
The crime victims program continues to help so many in need here in our very own El Paso. As a practicing Chiropractor, I have seen more than my share of domestic dispute violence drama and the physical toll on individuals and families. We touch these individuals and work on their bodies after the ordeals they undergo at the physical and emotional levels. It is this proximity to our patients that allows us to see firsthand the true effects. Logically, the impact of the unseen consequences may not always be physical in nature; the program’s outreach covers the unseen concomitant emotional damage caused by the crimes. The attorney general and district attorney have pledged continued support of this outstanding program. This continues to be great news in our growing city.
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