September 15, 2022 Recap – Trauma-coerced Attachment and Complex PTSD: Informed Care for Survivors of Human Trafficking

HT-RADAR Quarterly Research Meeting presents Dr. Ronald Chambers Jr. on Trauma-coerced Attachment and Complex PTSD: Informed Care for Survivors of Human Trafficking

Quarterly Meeting Recording

Video Time Stamps

• 00:00 – Medical Safe Haven Overview

• 16:15 – Presentation: Trauma-coerced Attachment and Complex PTSD

• 49:25 – Q & A

Presentation Slides

TCA & C-PTSD (HT-RADAR)

• Trauma-coerced Attachment and Complex PTSD: Informed Care for Survivors of Human Trafficking
• Training Residents on Understanding Trafficked Humans (TRUTH)
• Trauma Informed Care: Trafficking Out-Comes (TIC TOC Study)
• Toolkit: Survivor-Informed Practice Self-Guided Assessment
• Healthcare Provider Human Trafficking Training Assessment Tool

• Resources for Residency Programs and Physicians 
• Human Trafficking Medical Safe HavenProgram and Shared Learnings Manual
• What is a Medical Home? – Ending Human Trafficking Podcas with Dr. Chambers

Questions & Answers

No asterisk means Dr. Chambers responded via email after the presentation
*Dr. Chambers responded to these questions live at the end of the presentation.
**These responses were compiled by HT-RADAR.

How long ago did Dignity Health begin focusing on treating human trafficking survivors?

2014-15

How many HT survivor patients are your findings based on?

600 patients, 4000 visits

 

**The study cites over 3,000 patient visits across all Medical Safe Haven locations.”Trauma-coerced Attachment and Complex PTSD: Informed Care for Survivors of Human Trafficking” was published in Jan 2022. The figure has grown significantly since it’s publication

Do you have contacts down here in San Diego to whom we can send victims/survivors for medical care? 

**HT-RADAR recommends connecting with the San Diego Regional Human Trafficking/CSEC Advisory Council- Health Subcommittee. Reach out to the Co-Chair Amy Sharpe at shortamy@gmail.com and/or subscribe to their listserv here.

Can we get the contacts of your clinics across the state?

Medical Safe Haven Sites: 

Sacramento – (916) 835-9488

Redding – (530) 355-6558

Northridge – (818) 439-0878

Santa Maria – (805) 800-2276

San Francisco – Coming early 2023

Merced – Coming in 2023

 

**All Medical Safe Haven locations can be found online by going to the Dignity Health home page and selecting the location on the top right option “Our Locations”. The program is in 6 locations across the state (pictured below).

 

Are you or one of your PI assistants available to present a lecture to my students? I have my students do a module on mandatory HT reporting. If so, do you have specific presentations for Psychology/Nursing/Physician Assistant students?

Yes, contact Gigi Barrios at gigi.barrios@commonspirit.org or Jennifer Cox at jennifer.cox@dignityhealth.org and they can coordinate that.

What is your protocol for treating an HT victim who does not identify as being trafficked?

This is a very long answer, basically work with them through the transtheoretical model of change.

 

**All protocols are found in the Human Trafficking Medical Safe HavenProgram and Shared Learnings Manual

I am working on the side of prevention in survivor-led and research-informed programming for K-12 and adults. I am grateful for your work! Hearing your presentation was excellent for reinforcing why working upstream to prevent sexual trafficking from happening in the first place. Would you consider presenting to our groups in Canada?

Yes, contact Gigi Barrios at gigi.barrios@commonspirit.org or Jennifer Cox at jennifer.cox@dignityhealth.org and they can coordinate that.

We have folks that may or may not have a diagnosis for [Complex PTSD]. Do you just assume that is going on with this population or is it tailored to the individual where they go through that PTSD symptomology and have to get a certain [score] to diagnose them?

*I absolutely don’t assume, people have different levels of cognitive resiliency. Some patients have incredible histories of trauma and exploitation and seem to have minimal ramifications somehow. And then there are also people who have significant Complex PTSD symptomatology from experiences where you wouldn’t expect it. So no, it is definitely person dependent.

I am working with nursing students to recognize, but what do we do with the staff who are currently in the hospital letting these victims go because they don’t recognize what is going on?

*Well, you are talking about a systemic issue, in my opinion, nationally it is an issue. There are a lot of opinions that say we should educate everybody and they should want to do it. And yeah, that’s great, but I don’t feel like it’s realistic. I wish Joint Commission would come in or CMS (Centers for Medicare & Medicaid Services) and mandate protocols so that you had to have everyone trained. You’d have to have a protocol in place and you’d have to verify that you did all of it during their surprise site visits. I am Chief of Staff at the hospital. If they give us a new protocol, guess what? We all jump through every hoop to learn it and implement it. It’s like my hospital president will put in the funds that we need to do it. I know it’s a big stick and no one wants to use the stick, but if we used it in this one case, then everyone would have to do it and we’d all move forward. You wouldn’t have situations like this where no one is educated or trained.

My experience is that we go to hospitals and hospital systems. We beg, plead, and until finally if I get in front of somebody with enough clout and give them a sales pitch, they usually bite. They say, “Wow this is important, I didn’t know.” And then they do it. You have to go through that process each and every time. And then three years later, that person transitions into a new job and the protocols fall apart and there are no resources dedicated to it.

I am of the opinion that we need a systemic change in protocols to be mandated across the country. And I think this education needs to be in medical education and it needs to be a requirement.

What happens if you are kept on the meds for 20 years? Getting off of them has led to bad psychological consequences. (How can one wean off of them?)

Everyone is different and being on them long term may be the best option for some.

What can be helpful for a sex trafficking client who had drug abuse issues coming out of prison into a halfway house who has weaned off suboxone but is expected to go back to the suboxone or methadone treatment against her will?

I have not heard of that. It does not sound ethical, but I imagine this is a complicated story and do not know enough to provide any insight. I would work with their physician and case worker on the issue if possible.

Do you treat Sex Industry survivors as well as human trafficking survivors? Many agencies differentiate between the two.

We follow AMP (Action, Means, Purpose for defining HT specifically. See all.)

Speaker Bio

Dr. Ronald Chambers Jr. attended medical school at George Washington, residency at Dignity Health Methodist Hospital, completed fellowships in Faculty Development, Program Director Development, and earned the title of Fellow of the American Academy of Family Physicians. He is the DIO and Program Director for the Dignity Health Methodist Family Medicine Residency Program, Chair of the Family Medicine Department, Chief of South Sacramento Hill Physicians, Medical Director for Mercy Medical Safe Haven Clinic, Physician Advisor for the Dignity Health Human Trafficking Response, Clinical Faculty for UC Davis School of Medicine, and Clinical Associate Professor for California Northstate College of Medicine. He is passionate about the acute and longitudinal care for patients who have experienced exploitation through human trafficking and the creation of trauma-informed, victim-centered “Medical Safe Havens” for survivors coinciding with resident physician education and training.  With promising outcomes for over 2000 patient visits provided the Medical Safe Haven is a low cost and sustainable model that, if replicated, could provide widespread care while concurrently training the physicians of tomorrow to appropriately identify, respond to, and longitudinally treat this vulnerable patient population.

Presentation Description

The trauma experienced within the trafficking victim population is frequently chronic and complex, and may coincide with time frames of brain development leading to specific manifestations of complex post-traumatic stress disorder (complex PTSD), intermixed with trauma-coerced attachment (TCA) – often referred to as trauma bonding- to the abuser(s). Healthcare providers need to consider incorporating both psychological and pharmacological treatments to adequately address complex PTSD with concurrent TCA. However, more research and a better understanding of effective approaches for treating trafficking-related PTSD are essential to better inform survivor-centered care. Here, we present a conceptual understanding of trauma-coerced attachment and complex PTSD in trafficking victims, as well as an approach to comprehensive, trauma-informed care used at our medical safe haven (MSH). Improving the ability of healthcare professionals to effectively treat the psychological trauma of trafficked persons in a trauma-informed manner contributes to UN Sustainable Development Goal 16: Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels.