The IHS is Raising Human Trafficking Prevention Efforts in Indian Country

The Indian Health Service is dedicated to raising human trafficking awareness and prevention efforts and each January we reaffirm our commitment to improving medical forensic healthcare for individuals who have experienced human trafficking. The Forensic Nursing Consultation Program contract was awarded to Texas A&M University Center of Excellence in Forensic Nursing for providing training and education for providers to become trained as forensic healthcare providers. Through this contract, they have subcontracted with Nurses United Against Human Trafficking (NUAHT), an organization that is committed to providing human trafficking education, resources and supporting best practices for healthcare providers. Since the inception of the contract, over 60 of our fellow colleagues from Indian Health Service, tribal, and urban Indian organization facilities have obtained training through NUAHT.

What is human trafficking? Human trafficking is a crime that involves compelling or coercing a person to provide labor or services, or to engage in commercial sex acts. The coercion can be subtle or overt, physical or psychological. Exploitation of a minor for commercial sex is human trafficking, regardless of whether any form of force, fraud, or coercion was used. The Trafficking Victims Protection Act of 2000 defines "severe forms of trafficking in persons" as:

• Sex trafficking: the recruitment, harboring, transportation, provision, obtaining, patronizing, or soliciting of a person for the purpose of a commercial sex act, in which the commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such act has not attained 18 years of age.
• Labor trafficking: 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.

What are some common red flags or indicators associated with human trafficking? Please know that an individual might not experience any potential red flags or indicators. As providers we must follow best practices, and conduct culturally-responsive, trauma-informed safety screening. Red flags can include, but are not limited to:

• Physical: bruises, swelling, pattern of injuries, or frequent STIs
• Behavioral: depression, anxiety, psychological trauma, inability to focus or concentrate, hypervigilant or paranoid, experience guilt or shame, unaware of location, date, or time, or avoiding or dissociating
• Environmental: not allowed to take breaks, eat or drink, accompanied by a person who will not leave them alone and constantly answering for the individual, living at work or in overcrowded locations, experiencing homelessness/unhoused situations, or not in possession of their own identification
• Spiritual: loss of spiritual identity, or withdrawn from religious beliefs, traditions, customs, or ceremonies

The National Congress of American Indians Policy Research Center surveyed four sites in the U.S. and Canada as part of a 2015 report, with an average of 40 percent of women involved in sex trafficking identified as American Indian or Alaska Native. Human trafficking holds a strong, if not direct correlation, to the missing and murdered Indigenous relatives' crisis. In communities so full of light, there is no capacity for violence such as human trafficking. Preventing human trafficking starts with us, holding each other accountable to ensure healthier communities and outcomes across the nation. Secretary of the U.S. Department of Health and Human Services Xavier Bacerra, stated in a press release aiming to protect youth from human trafficking that "we must do whatever we can, for as long as necessary, to end the scourge of human trafficking." The Office on Trafficking in Persons, Administration for Children & Families, coined this year's Human Trafficking Prevention Month's theme as - Connecting the Dots. Strengthening Communities. Preventing Trafficking. Please join us by wearing blue on January 11 to help support human trafficking awareness and raise prevention efforts on #WearBlueDay.

Related Information:

• If you or someone you know is affected by human trafficking, contact the National Human Trafficking Hotline to report a trafficking tip, for resources to stay safe, and other information. Confidential 24/7 Help is available by phone: 1-888-373-7888; TTY: 711; Text 233733; Online chat; or email [email protected].
• National Human Trafficking Training and Technical Assistance Center (NHTTAC) - training/technical assistance to inform and enhance the public health response to human trafficking.
• HHS 2025 Human Trafficking Prevention Month Toolkit - Office of the Administration for Children and Families.

Provider Resources:

• The IHS Forensic Healthcare webpage offers a variety of resources, including provider guidebooks, forensic-related health topics, programs and initiatives, provider resources, training, policies, and a sign-up option for the Forensic Healthcare Listserv.
  • The IHS awarded the Forensic Nursing Consultation Program contract to Texas A&M University Center of Excellence in Forensic Nursing to provide education, training, and mentoring resources to boost forensic health care related workforce activities across all facilities. Through this contract, training modules specific to human trafficking are available through Nurses United Against Human Trafficking (NUAHT).
  • If you or someone you know if interested in obtaining training either through TAMU CEFN or NUAHT, please reach out to Nicole Stahlmann at [email protected].
• SOAR - The SOAR for Indigenous Communities training is for those working with human trafficking in Indigenous communities.
• Adult Human Trafficking Screening Tool and Guide - Training guide for health professionals to use trauma-informed and survivor-informed assessment and care practices.
• Blue Campaign - Protecting native communities from human trafficking.

Nicole Stahlmann, MN, RN, SANE-A, AFN-BC, SANE-P, FNE-A/P, serves as the forensic nursing consultant with the IHS Division of Nursing Services. Prior to her work with IHS, she served as a forensic nursing specialist with the International Association of Forensic Nurses and was the clinical program manager for the District of Columbia Forensic Nurse Examiners. Stahlmann was an emergency department nurse and adjunct instructor, teaching both undergraduate and master prepared students at Georgetown University. She continues to practice clinically, providing care for patients who have experienced violence.