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201 N King of Prussia Rd Suite 370 Radnor, PA 19807Phone. (843) 488-5550 Web. www.freeCE.com Email. support@freeCE.com Fax. (843) 488.5554Human Trafficking and How Pharmacy Can Make aDifference – FL APPROVEDFacultyKeith M Binion, BS, CPhTProgram Director,Pharmacy Technician Program, Henry Ford CollegeHuman trafficking is today’s modern form of slavery. It is the second-largest criminal activity in the worldand is a growing phenomenon. Trafficking typically originates in disadvantaged areas with a high level ofpoverty, lack of opportunity, and high crime rates but can also exist in communities of any socioeconomicclass.Traffickers often lure victims by promising reliable income and opportunity if they agree to work withthem. However, the traffickers then keep victims enslaved by way of several different techniques that allwork to instill fear into the victim in order to keep them compliant. The fear and/or feelings of loyalty toperpetrators that victims experience is the driving force behind their continued captivity. This programwill examine these factors using a case-based approach and educate pharmacy technicians on their rolein putting a stop to human trafficking.This course has been FL BOARD APPROVED to meet the requirement for 1.0 hour of continuing educationon the topic of Human Trafficking for Pharmacy Technicians ONLY.Learning ObjectivesPharmacy Technician1. Define the types of human trafficking, its venues and who it affects.2. Recognize the warning signs of trafficking and how to identify trafficking victims in pharmacy andhealth care settings.3. Identify resources for pharmacy personnel to report trafficking and provide support to suspectedvictims.4. Recognize how to report cases of human trafficking1Human Trafficking and How Pharmacy Can Make a Difference – FL APPROVED(c) 2021 PharmCon
AccreditationPharmCon is accredited by the Accreditation Councilfor Pharmacy Education as a provider of continuing pharmacyeducation.PharmCon reports CPE credits to CPE Monitor automaticallyafter credit is earned. Your NABP ePID and birthdate must bein your online profile for successful credit submission.PharmCon reports CPE credits to CE Broker automaticallyafter credit is earned. Your license number must be in youronline professional profile for successful credit submission.PharmCon is approved by the California Board of RegisteredNursing (Provider Number CEP 13649) and the Florida Boardof Nursing (Provider Number 50-3515). Activities approvedby the CA BRN and the FL BN are accepted by most StateBoards of Nursing.CE hours provided by PharmCon meet the ANCC criteria forformally approved continuing education hours. The ACPE islisted by the AANP as an acceptable, accredited continuingeducation organization for applicants seeking renewalthrough continuing education credit.Target AudiencePharmacy TechniciansUniversal Activity NumberPharmacy Technician0798-0000-21-123-L04-TCredit Hours1.0 HourActivity TypeApplication-BasedCE Broker TrackingNumber20-848912Activity Release DateJune 1, 2021Activity Offline DateJune 1, 2024ACPE Expiration DateJune 1, 2024Educational Support Provided ByPharmConAll opinions expressed by the author(s) are strictly their own and not necessarily approved or endorsed byPharmCon FreeCE.Consult full prescribing information on any drugs or devices discussed.PharmCon FreeCE is a division of Knowfully Learning Group.201 N. King of Prussia Rd, Suite 370, Radnor, PA 19807 2021 PharmConAll rights reserved.None of the contents of this publication may be reproduced in any formwithout the written permission of the publisher.2Human Trafficking and How Pharmacy Can Make a Difference – FL APPROVED(c) 2021 PharmCon
Faculty Disclosure Keith M Binion declares no existence of a financial interest in anyamount related to the content of this activity. Advisory Board members and other individuals, not previouslydisclosed, who may review, propose recommendations, and/or editthe content of PharmCon CE activities declare no existence of afinancial interest in any amount related to the content of this activity.Human Trafficking andHow Pharmacy Can Make a DifferenceKeith M Binion, BS, CPhTProgram Director, Pharmacy Technician Program Henry Ford College1 2021 PharmCon2Learning ObjectivesHuman TraffickingAt the conclusion of this activity, participants should be better able to:Human trafficking is defined by the United Nations Office on Drugs andCrime (UNODC) as the “recruitment, transportation, transfer, harboringor receipt of persons (the act), by means of threat or use of force orother forms of coercion, of abduction, of fraud, of deception, of theabuse of power or of a position of vulnerability or of the giving orreceiving of payments or benefits to achieve the consent of a personhaving control over another person (the means), for exploitation (thepurpose).” Define the types of human trafficking, its venues and who it affects. Recognize the warning signs of trafficking and how to identify traffickingvictims in pharmacy and health care settings. Identify resources for pharmacy personnel to report trafficking and providesupport to suspected victims. Recognize how to report cases of human trafficking 2021 PharmCon3 2021 PharmCon4Highest States with Human Trafficking per 100KHuman Trafficking Statistics by State, 20211. Nevada (7.50 per 100k)StateRate per 100KHuman Trafficking CasesMontana3.50382. Mississippi (4.99 per 100k)3. Florida (4.08 per 100k)6. Delaware (3.84 per 100k)7. California (3.80 per 100k)8. Missouri (3.78 per 100k)4. Georgia (3.85 per 100k)9. Michigan (3.64 per 100k)5. Ohio (3.84 per 100k)10. Texas (3.63 per 187Oregon3.08132New Mexico3.0464 2021 PharmCon5 2021 PharmCon63Human Trafficking and How Pharmacy Can Make a Difference – FL APPROVED(c) 2021 PharmCon
Human Trafficking Statistics by State, 2021Human Trafficking Statistics by State, 2021StateRate per 100KHuman Trafficking CasesStateRate per 100KHuman Trafficking CasesKentucky3.04136Tennessee2.59180North Dakota2.9923Hawaii2.4935Colorado2.99176North Carolina2.49266Arkansas2.8386New York2.35454South Dakota2.7925Indiana2.31157189New Jersey2.78247Virginia2.20Oklahoma2.73109West Pennsylvania2.12271South Carolina2.63139Alaska2.0715 2021 PharmCon7 2021 PharmCon8Human Trafficking Statistics by State, 2021The OffendersStateRate per 100KHuman Trafficking ermont1.449 Most are male Women also Members of organized crimegroups Celebrities and influential people Smaller groups operating onopportunitiesIdaho1.4026Rhode Island1.3214New Hampshire1.0915 2021 PharmCon9 2021 PharmCon10The OffendersThe Offenders’ Strategies Look at victims as commodities Utilize social media forrecruitment Target those looking forfriendship, attention, andacceptanceHunting Victims are activelypursued Social media or othermethods Instagram, Facebook,other messaging routes 2021 PharmCon11Fishing Posting fakeadvertisements Job recruitments Events in secludedplaces 2021 PharmCon124Human Trafficking and How Pharmacy Can Make a Difference – FL APPROVED(c) 2021 PharmCon
Human TraffickingHuman Trafficking Traffickers lure victims bypromising reliable income Traffickers keep victims throughvarious techniques designed toinstill fear for compliance Illegal and punishable by law:The Trafficking VictimsProtection Acts (TVPA) of 2000 First federal law to combat humantrafficking Serves to improve publicawareness Makes victims eligible for benefits Education Healthcare Employment Financial obligations Isolation from the public Confiscation of identification anddocuments Deportation Threats of violence 2021 PharmCon13 2021 PharmCon14Types of Human TraffickingSex Trafficking Sex Trafficking Forced Labor Child Labor Child Soldiers Debt Bondage Involuntary Domestic ServitudeThe recruitment and transportation ofpersons (men, women, boys, or girls)through threat or force for the purposeof sexual exploitation, includingprostitutionOf the 21 million victims of trafficking,4.5 million are victims of forced sexualexploitation 2021 PharmCon15 2021 PharmCon16Forced LaborChild Labor Individuals are coerced or forcedto work for free or for less thanstandard wages More common amongstimmigrants Can occur in all ethnicities Children are forced or coerced towork for the trafficker either byphysical or psychological force Minors under 18 CANNOTconsent to labor exploitationsunder any circumstance 2021 PharmCon17 2021 PharmCon185Human Trafficking and How Pharmacy Can Make a Difference – FL APPROVED(c) 2021 PharmCon
Debt BondageInvoluntary Servitude Debt slavery/bondage slavery Traffickers require labor for therepayment of a real or allegeddebt The victim’s wages are neverapplied to the debt The amount of work or durationneeded by the individual is neverdefinedInvolves domestic workers who live and work in the samesettingIn private settings, authorities don’t and can’t routinely inspectlike normal workplacesVictims may not receive payHeld captive through force or psychological means 2021 PharmCon19 2021 PharmCon20Child SoldiersStop and Reflect Girls and boys under 18 years of agewho have been recruited by armedforcesSam is a 10‐year‐old boy who works on a peanut farm at the request ofhis parents. When interviewed, he states that he has to sleep outside,is not provided any shelter, and does not have any parental supervision.He says he doesn’t have time to play or go to school, but he doesn’tmind because he is helping his family out by being on the farm andworking. Is Sam a victim of human trafficking? Rebel organizations or governmententities Required to fight, cook, work, spy, actas messengers, perform sexual favors 19 countries have been reported touse child soldiers in the national armyor armed opposition groups 2021 PharmCon21 2021 PharmCon22Venues of Human TraffickingVictim Characteristics and Risk Factors Most common is prostitution Escort services Residential businesses Delivery services Massage parlors Farms and large businessesMore common in women11.4 million victims are women, 9.5 million victims are male1.8 million children worldwide are exploited in child sex traffickingSex trafficking white or black, more likely identified as U.S. citizensLabor trafficking Asian or Hispanic, often undocumented or qualifiedaliens 2021 PharmCon23 2021 PharmCon246Human Trafficking and How Pharmacy Can Make a Difference – FL APPROVED(c) 2021 PharmCon
Consequences of Human TraffickingConsequences of Human TraffickingProlonged and repeated traumaPhysical Health ComplicationsNeurological deficits92% of victims have reported being burned, kicked,punched, beaten, stabbed, raped, or abusedMemory impairment71% Unwanted pregnancy in femalesReduced appetite55% are abortedWeight loss/malnutritionHeart issues53% are forced abortionsDental problems 2021 PharmCon25 2021 PharmCon26Consequences of Human TraffickingMisconceptions of Human Trafficking98% report long lasting depressionPTSDSuicidal ideationsMisconceptionExplanation“Human trafficking does not happen in theUnited States.”This statement is false. Human trafficking existsin every country, including the U.S.“Victims of human trafficking are only foreignborn and poor females.”This is false. Victims can be any age, race, genderor nationality and may be of any income level.“Human trafficking is sex trafficking.”Sex trafficking is a type of human trafficking.There are many types of human trafficking,including forced labor. An example of forcedlabor is the use of individuals in “sweatshops”.High rate of STDsLink to HIV/AIDS 2021 PharmCon27 2021 PharmCon28Misconceptions of Human TraffickingRole of Healthcare ProvidersMisconceptionExplanation“To be considered a victim of trafficking, the individualmust be forced or coerced into the act.”This is false. Some minors under the age of 18 havebeen identified as victims of human trafficking andmay say that they are not a victim and want tocontinue. However, minors under the age of 18cannot consent to any exploitation under anycircumstance, including labor exploitation.“To identify a victim of human trafficking, there mustbe signs of physical restraint, physical force or physicalbondage.”Trafficking does not require physical restraint, force orharm. Traffickers can utilize psychological techniquesto keep the victim captive, such as threats or fraud. Placed in a unique position toidentify and offer assistance Studies show 28‐50% oftrafficking victims in the U.S.encounter a health careprofessional We as pharmacists andpharmacy technicians shouldlearn warning signs“Foreign victims are always undocumented immigrants Although some foreign victims are undocumentedand/or here illegally.”and illegal aliens of the United States, not all foreignvictims are in the U.S. illegally; some are in the U.S.with legal visas for a number of reasons. 2021 PharmCon29 2021 PharmCon307Human Trafficking and How Pharmacy Can Make a Difference – FL APPROVED(c) 2021 PharmCon
Identifying Victims in Health Care Settings:General Warning SignsIdentifying Victims in Health Care Settings:Warning Signs of Trafficking in ChildrenInjuries or signs of physical abuse*Does not know their home or work addressNo access to parents/guardiansMalnourished (deprivation of food, water, sleep,medical care, etc.)Avoids eye contactNo time for playLives apart from other childrenDisorientationAlways wearing the same clothes, regardless ofweatherNo friends outside of work or schoolTravels alone without an adultLack of identification documentsFearful of law enforcementFew personal belongingsCannot freely contact friends or familyNervous or hesitant to talk to strangersRarely allowed out aloneUnable to recall his or her own addressFearful, anxious and submissivePoor living conditionsNo educationOnly provided leftovers for foodAppear intimidated in a way that isatypical for their ageReports that they eat apart from othermembers in their family/homeTravel in groups that are unrelated to the Engaged in work or other activities notindividualsuitable for childrenMinor who appears to be in a relationship with a Works long hours and unable to leave workmuch older personenvironment 2021 PharmCon31 2021 PharmCon32Red Flags in the Pharmacy andOther Healthcare SettingsStop and ReflectJennifer is a 27‐year‐old female admitted to the hospital with bleeding, bruisingand swelling all over her body. You are the pharmacist in charge of doing Jennifer’smedication reconciliation.Upon conversing with Jennifer, you realize she seems hesitant and nervous to talkwith you and she appears to avoid eye contact with you and other members of thehealth care team. Being a concerned pharmacist, you begin to interview Jenniferabout what brought her into the hospital and try to get to know her better. She saysall she remembers is falling down and everything is a little blurry from there. Whenasked about her employment, she says she has a job; however, she doesn’t knowwhere the job is located. Feeling concerned for Jennifer, you ask her if she has anyfriends or family that she can contact while in the hospital, but just as she wasabout to answer, a man walks into the room and introduces himself as Steve.When you ask Jennifer what Steve’s relationship is to her, Steve speaks up andinforms you that he is her boyfriend, and he wants to know what is the purpose ofyou being in the room. What warning signs of trafficking does Jennifer display? Victim is often escorted to and from appointmentsand the escort may often talk for the patient Inconsistencies in the story provided by the victim Victim may be unsure how they were injured May have multiple STDs and may be unclear onhow they contracted a disease May request for documentation or certificationthat they no longer are infected with an STD 2021 PharmCon33 2021 PharmCon34Red Flags in the Pharmacy andOther Healthcare SettingsRed Flags in the Pharmacy andOther Healthcare Settings Evidence of lack of health care‐advanced symptomsand old or untreated injuries. Presence of branding, scarring or tattoo indicatingownership by someone No insurance coverage/cash payments Pregnancy tests or multiple pregnancy concerns Prescriptions are routinely lost or stolen Patient often calls for early refills Frequent injuries Pain level remains unchanged, despite painmedications patient is taking Frequent filling of medications for STDs Oral contraception in young women 2021 PharmCon35 2021 PharmCon368Human Trafficking and How Pharmacy Can Make a Difference – FL APPROVED(c) 2021 PharmCon
Screening Questions to Ask as aHealthcare ProfessionalScreening Questions to Ask as aHealthcare Professional1. Are you being forced, or have you ever been forced to dosomething you do not want to do?2. Can you leave your current situation if you wanted to?3. Have you or anyone in your family ever been threatened if you triedto leave your current situation?4. Have you ever been physically harmed?5. What are your work and living conditions like?6. Where do you sleep and eat?7. Has anyone ever withheld food, water or sleep from you?8. Do you have to ask permission to do essential daily living activitiessuch as use the bathroom, sleep or eat?9. Are there locks on windows or doors that prevent you from leaving?10. Has your identification or documentation been taken away fromyou? 2021 PharmCon37 2021 PharmCon38Suggested Questions to Ask Based on the Type ofSuspected TraffickingFraud/Financial CoercionSuggested Questions to Ask Based on the Type ofSuspected Trafficking How did you get your job? Are you getting paid to do your job? Do you have a check stub or receiptsof payment? Do you have your own legaldocuments? Immigrants: Physical AbuseWhy did you come to this country?How did you get here?Who promised you this job?Is the job what you were promised?Who organized your travel? Has anyone threatened harm toyou/a loved one if you triedleaving? Have you or your family everbeen threatened? Has anyone ever harmed you orothers around you? Were there weapons involved? Were legal authoritiescontacted? 2021 PharmCon39 2021 PharmCon40Suggested Questions to Ask Based on the Type ofSuspected TraffickingFreedomSuggested Questions to Ask Based on the Type ofSuspected Trafficking Do you live and work in thesame place?Psychological Coercion Have you ever been detainedagainst your will? If so, have youever been restrained throughlocks or chains? Who are you afraid of? Why are you afraid of them? What is your opinion of thepolice? 2021 PharmCon41 2021 PharmCon429Human Trafficking and How Pharmacy Can Make a Difference – FL APPROVED(c) 2021 PharmCon
Barriers to ReportingResources and Phone Numbers National Human Trafficking Resource Center: 1‐888‐373‐7888 Law enforcement for human trafficking: 1‐866‐347‐2423 or call 911 inan emergency U.S. Department of Justice Worker Exploitation Complaint Line: 1‐888‐428‐7581 ICE’s Victim Assistance Program: 1‐866‐872‐4973Not being taken seriously Retaliation to the victim HIPAA Violations 2021 PharmCon43 2021 PharmCon44Stop and ReflectKey TakeawaysYou are practicing in a community pharmacy and a customer namedFrank, who you know well, comes in to pick up a prescription. You twoget to talking and he, knowing that you are a trusted healthprofessional, asks for advice about his neighbor, Diego, whom he isconcerned for.Diego is an immigrant from Colombia and Frank, being a concernedfriend, worries about Diego’s working conditions. He is worried hisfriend is being coerced into working for his boss so that he cancontinue to live in America. Frank desperately wants to help Diego andasks for your advice on how to deal with the situation. Frank asks if youhave any resources that you could point him to.What resources would you give to Frank? Healthcare professionals have a duty and obligation to help Be observant Recognize key indicators Age is not limited Human trafficking is not only sex trafficking All individuals are not poor Individuals don’t have to be forced Know how to help 2021 PharmCon45 2021 PharmCon46Thank You 2021 PharmCon4710Human Trafficking and How Pharmacy Can Make a Difference – FL APPROVED(c) 2021 PharmCon
201 N King of Prussia Rd Suite 370 Radnor, PA 19807 Phone. (843) 488-5550 Web. www.freeCE.com Email. support@freeCE.com Fax. (843) 488.5554 Human Trafficking and How Pharmacy Can Make a Difference - FL APPROVED Faculty Keith M Binion, BS, CPhT Program Director, Pharmacy Technician Program, Henry Ford College
