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The following sections are adapted from the IOM Handbook on Direct Assistance for Victims of Trafficking (2007). The Guidelines on Protecting the Confidentiality and Security of HIV Information: Proceedings from a Workshop 15-17 May 2006 Geneva, Switzerland, Interim Guidelines (UNAIDS, Geneva, 15 May 2007) in particular were also consulted as an important source.
CARING FOR TRAFFICKED PERSONS: GUIDANCE FOR HEALTH PROVIDERS
Personal information, including medical history-taking, must be collected in a private setting. Both the patient and the provider must feel safe to speak freely. It is a good idea to ask individuals if they feel comfortable and ready to discuss their health and care needs. Consider, for example, whether the individual wants the door open or closed, discourage other staff from interrupting, and turn off your mobile phone.
• obtain informed consent: The fundamental element of ‘informed consent’ is informing, by providing clear and accurate information. At the first health consultation, providers should offer information about the scope and purpose of the consultation, services that are and are not available and the measures in place to ensure patient privacy and confidentiality.
Once information on data use is provided, an individual may be asked for consent to proceed. Only information covered in the scope of the consent may be requested. If information is to be used for research purposes, this must be disclosed and separate consent may be required. Informed consent is when patients are able to consider the relevant facts (purposes, procedures, uses, risks and benefits) associated with data collection and then agree. If consent cannot be obtained because, for example, the trafficked person is a minor, is in a state of trauma or has a physical or psychological disability that would prevent him or her from giving truly informed consent, the health care provider should, at a minimum, ensure that the patient understands sufficiently and appreciates the specified purpose for which personal data are collected and processed.
The condition and legal capacity (e.g., if the patient is a minor) of the patient to give consent should be taken into account.
The patient must also be allowed to give, withhold and withdraw consent at any time without negative consequences (see action sheet 16).
• Collect pertinent data. Collect only information that is required to assess and respond to care needs, not simply for curiosity’s sake. Refrain from asking trafficked persons about the non-health related consequences of the trafficking process. This may put you in a risky situation and may cause the trafficked person to relive stressful experiences, which may have a negative impact on recovery. Many victims of sexual abuse feel stigmatised by their experience and by certain health problems (e.g., sexually transmitted infections or psychological disorders).
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Caution! Even when coding is used, individual patients often can be readily identified by their basic data (demographic background, ethnicity, nationality, date of birth, family data, description of elements of the trafficking process, etc.). Only key health care providers and support staff should have access to a patient’s primary case file.42 Adapted from The IOM Handbook on Direct Assistance for Victims of Trafficking, IOM (2007).
• Conduct a data risk analysis. Providers caring for trafficked persons may wish to undertake a data risk analysis to consider the implications of what is written in a file, the potential uses and misuses of patient data and to develop strategies to avoid mishandling of data and to deal with information requests. File information may, for example, be required by law enforcement in relation to a court case against an alleged trafficker or needed for an asylum claim. In more sinister situations, traffickers might try to obtain the trafficked person’s file information to locate individuals or learn about their health conditions. It is equally important to remember that personal data (name, work location, phone number, etc.) of the health care provider could also be misused. It is therefore important to follow well-designed data security procedures (please see below).
Information communication to patient All trafficked persons have the right to be fully informed of their medical conditions and health needs and should receive copies of their complete medical and health records.
• full and clear communication of information to patient.
Trafficked persons should be fully informed of their medical conditions, diagnoses, test results, health needs and proposed follow-up procedures, which are also recorded in their file.
They should be offered copies of their complete medical records. Patients should be given an opportunity to verify and rectify their personal data.
Information communication to others
Sharing case information among health professionals is often necessary for good case management. Health files, electronic data and verbal case information must be transferred to other health practitioners in an efficient and careful manner carefully. All health care providers and support staff,
including interpreters, should adhere to the following:
• Health files and information should not be disclosed to third persons without the prior consent of the patient.
• only ‘need-to-know’ information should be transferred to others. Only information that is pertinent to an individual’s safety and care should be disclosed to other internal or external parties, on a ‘need-to-know’ basis and with the consent of
112 CARING FOR TRAFFICKED PERSONS: GUIDANCE FOR HEALTH PROVIDERS
What do I do if the patient’s health data is requested by a law enforcement agency in relation to a criminal investigation against an alleged trafficker?
Your cooperation might be requested by law enforcement officials for a criminal proceeding against an alleged trafficker, or in relation to an asylum or temporary residency claim by a trafficked person. You may be required to submit a written statement or appear in court. To be certain of your compliance requirements, seek legal counsel.
Procedures and training in data collection and security
Providers caring for trafficked persons must design and document special procedures for collecting, storing and communicating patient information in high-risk cases. Staff should all be made aware of the procedures and particularly the limits of communication of patient information. All staff should be made aware of file security procedures and of procedures to follow if they become aware of safety risks or security breaches.
In certain cases or for therapeutic reasons, it may be useful to offer examples from a case similar to the trafficked person’s experience. If this is done, it is necessary to change names and sufficiently alter personal details so that the case being discussed cannot be identified. From The IOM Handbook on Direct Assistance for Victims of Trafficking, IOM (2007).
CARING FOR TRAFFICKED PERSONS: GUIDANCE FOR HEALTH PROVIDERSRefeRenCeS And ReSouRCeS Council of Europe 2005 Council of Europe Convention on Action Against Trafficking in Human Beings, treaty open for signature by the member states, the non-member states which have participated in its elaboration, and by the European Community, and for accession by other non-member states, CETS no. 197, Warsaw, Poland, 16 May 2005.
European Parliament and the Council of the European Union 1995 “Directive 95/46/EC of the European Parliament and of the Council of 24 October 1995, on the protection of individuals with regard to the processing of personal data and on the free movement of such data”, Official Journal of the European Communities, no. L 231/81, 23 November 1995.
EuroSOCAP Project 2005 European Standards on Confidentiality and Privacy in Health Care, EuroSOCAP and Queen’s University, Belfast, November 2005.
International Organization for Migration 2008 Data Protection Principles: Information Bulletin IB/00047 2007 The IOM Handbook on Direct Assistance for Victims of Trafficking, IOM, Geneva, 2007, section 5.17.1.
Joint United Nations Programme on HIV/AIDS (UNAIDS) 2007 Guidelines on Protecting the Confidentiality and Security of HIV Information: Proceedings from a workshop 15–17 May 2006 Geneva, Switzerland, interim guidelines, UNAIDS, Geneva, 15 May 2007.
United Nations Children’s Fund 2006 Guidelines on the Protection of Child Victims of Trafficking, UNICEF Technical Notes, provisional version 2.1, UNICEF, New York, September 2006.
United Nations Office of the High Commissioner for Human Rights 2002 Recommended Principles and Guidelines on Human Rights and Human Trafficking, Report of the United Nations High Commissioner for Human Rights to the Economic and Social Council (E/2002/68/Add.1), United Nations Economic and Social Council, New York, 20 May 2002.
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RATIonAle The needs of trafficked individuals often go well beyond medical needs to include emergency food and shelter, as well as legal support to deal with immigration, criminal or guardianship matters. A strong referral network among medical professionals and other service providers is necessary to address these needs; referral is not simply a means of transferring an individual from one service to another, but is a fundamental part of providing care. To make a safe referral is to ensure that provision of assistance is handed over to other support services in a way that does not jeopardize the health or safety of the individual.44 This action sheet covers safe referrals and includes a form for ‘mapping’ possible referral partners in the community.
It is essential for health care providers to know where to refer a trafficked person for help before encountering the patient. At the same time, referral of trafficked persons is more complex than for other referrals, because of the range of services needed and the related security risks (see action sheets 6 and 7). It is not the responsibility of the health care provider to manage all the needs of the patient; yet the referral process does have the potential to either benefit or worsen a patient’s well-being. When referrals are well done, all care providers and the trafficked person feel informed and secure. Poorly thought out referrals, on the other hand, can put patients at risk and break the chain of care. This action sheet is designed to help health care providers develop and implement well-planned and well-executed referrals. It should be read together with action sheet 6.
National referral mechanisms are a key component of counter-trafficking activities. A national referral mechanism can be defined as “a co-operative framework through which state actors fulfil their obligations to protect and promote the human rights of trafficked persons, co-ordinating their efforts in a strategic partnership with civil society.” Organisation for Security and Co-operation in Europe (OSCE) / Office for Democratic Institutions and Human Rights (ODIHR), National Referral Mechanisms, 2004.
118 CARING FOR TRAFFICKED PERSONS: GUIDANCE FOR HEALTH PROVIDERSRequIRed ACTIonS In some countries a functioning referral system for trafficked persons may exist. Such systems link governmental and non-governmental organizations to coordinate the comprehensive assistance and protection needed by a trafficked person. Where such systems do not exist, it is essential to take the necessary steps to identify and assess available services.
Identify and assess services
Learn about the availability and quality of potential providers of the various services the might be needed by a trafficked person, so that you are prepared to refer your patient safely. These might include organizations providing social services, housing and legal aid; and government contacts in agencies such as law enforcement, consular services, and migration. See the mapping form at the end of this action sheet for more details. Whenever possible, try to assess (and record) the following qualities of each provider or
service to help inform future referrals:
Referral options should be reputable and well-established. It is beneficial to patients and to the referring organization to know whether the staff and key individuals at the referral organization provide non-discriminatory, supportive care to such marginalized groups as migrants, sex workers and minority populations. It can also be helpful to know which service providers have multi-lingual staff.
CARING FOR TRAFFICKED PERSONS: GUIDANCE FOR HEALTH PROVIDERSDevelop inter-organizational referral arrangements Whenever possible, determine agreed referral and information-sharing procedures before a referral takes place. Key components of a good referral
• Services that are provided by organization: Details of services that can and cannot be offered by service providers.
• How information and data will be transferred: Details about client information that will (and will not) be transferred to referral organization; how files and other information will be transferred; and how informed consent will be obtained (see action sheet 9).
• How information about services will be provided and patient consent requested: Referral options, arrangements and consent procedures must be clear.
• How the first contact will be arranged: Details about the first point of contact at each referring agency, including main contact person(s), times available, response times for getting called back, if required, and case data required at first contact.
• How the trafficked person will be released and received:
Arrangements about transfer to another agency or organization should include details about who has authority to arrange and confirm the referral and release any necessary file information;