Human trafficking is a significant public health concern in Wisconsin, with the National Human Trafficking Hotline reporting more than 1,000 human trafficking cases and 2,029 victims since 2007. Healthcare providers play a crucial role in identifying and supporting trafficking survivors, yet many providers don't feel confident in their ability to identify and care for victims. This gap in care is especially concerning given that survivors often have complex health needs resulting from physical and sexual violence, reproductive health issues, mental health challenges, and untreated chronic conditions. Without proper training and protocols, healthcare systems can create additional obstacles for survivors seeking essential medical care.
For survivors of human trafficking, accessing high-quality healthcare can be challenging due to past trauma, discrimination, and other barriers. With $399,618 in funding from the Advancing a Healthier Wisconsin Endowment (AHW), a team of researchers from the Medical College of Wisconsin (MCW) and community partners collaborated to develop solutions that would help trafficking survivors receive the care they need.
The Healthcare Coalition Against Sex Trafficking (HCAST) project—led by MCW’s Angela Rabbitt, DO, FAAP (Pediatrics), a specialist in child abuse pediatrics at Children’s Wisconsin and professor of pediatrics in the Division of Child Advocacy and Protection at MCW, along with co-investigator Wendi Ehrman, MD (Medicine), associate professor and co-chief of adolescent medicine at MCW, and Dr. Debbie Lassiter, executive director and co-founder of Convergence Resource Center—brought together state healthcare systems, community organizations, and trafficking survivors to develop protocols, treatment guidelines, and resources that improve access to trauma-informed healthcare for trafficking survivors in Wisconsin.
Dr. Rabbitt began her research into human trafficking response in 2013, focusing initially on understanding the scope of trafficking cases within pediatric healthcare. Partnering with Dr. Ehrman, their early work involved studying the experiences of young survivors through focus groups and examining healthcare providers' knowledge and needs when treating trafficked youth. They also collaborated with community partners to strengthen local response and investigation processes for trafficking cases.
As these earlier initiatives progressed, feedback from healthcare partners identified two crucial gaps: the need to expand trafficking response beyond children's healthcare systems and to develop better approaches for working with adult survivors, an area that had received limited attention in Wisconsin.
This led to an expanded partnership where Dr. Lassiter (Convergence Resource Center) was brought in to provide a community perspective on healthcare needs and barriers. The team conducted focus groups with adult women survivors and incorporated adult healthcare providers into the partnership, including Progressive Community Health Centers and 16th Street Community Health Centers, who brought expertise in community services. The collaboration then grew to encompass additional health systems across the region, and in 2019, they applied for and were rewarded the three-year AHW grant that would support this important work.
For their project, the team set out to transform healthcare delivery for trafficking survivors through systematic changes in Milwaukee-area health systems. Their plan centered on developing trauma-informed protocols and treatment guidelines, with different tiers of care standards to accommodate varying levels of resources across healthcare systems. The team focused implementation efforts on healthcare sites in areas with the highest needs, aiming to create a model that could eventually be expanded to additional facilities.
A key component of their strategy involved strengthening connections between healthcare providers and community services through IMPACT 211 (a 24/7 helpline connecting Milwaukee residents to health and social services). The team would create a vetted library of trafficking-specific resources and train IMPACT 211 staff to serve as an ongoing resource for both healthcare providers and community organizations.
Throughout all aspects of the project, the team sought to prioritize survivor input in developing education materials, treatment protocols, and referral guidelines, ensuring that those with lived experience would help shape the transformation of healthcare delivery.
When the project launched in January 2020, the team had to quickly pivot their plans as the COVID-19 pandemic emerged. While they managed to hold their first few meetings in person, the project team soon faced the challenge of transitioning to a virtual environment. They redirected funding to get the necessary technology platforms and brought on an experienced facilitator to help manage virtual collaboration among their large group of partners.
"It changed a bit of the makeup of people attending meetings because, even though you could do a lot with technology, people like to be in person. They liked being in the same room with people," Dr. Lassiter explained. "But I wouldn't say that it affected us being able to do what we needed to do."
Much of the project's core work took place during the height of the pandemic. As Dr. Rabbitt noted, "The bulk of the real work we did where we were meeting monthly and planning, creating the protocols and all of that, was done during the pandemic."
While this timing presented challenges with healthcare partner participation due to pandemic demands, "the core group that we had when we were going through the pandemic, they really stuck with us, and they were really the ones that stayed through the implementation phase," Dr. Rabbit added.
One of the team's proudest achievements was developing a comprehensive website—HCASTMKE.org—that serves as a hub of information and training resources. The site includes role-playing scenarios, protocols, and educational materials that are accessed by healthcare providers locally and internationally.
Beyond the website, the project helped create valuable connections throughout the community that continue to generate impact. These relationships have led to new initiatives, including an innovative proposal to have mental health professionals support trafficking survivors during medical exams.
"One of the biggest barriers for trafficking survivors seeking healthcare is the trauma that medical exams can trigger," Dr. Rabbitt explained. "Our next project would partner with mental health providers to help medical staff understand individual patients' trauma triggers and provide accompaniment in extreme cases."
The success of this project relied heavily on the team's ability to build trust and understanding across different perspectives and backgrounds. Dr. Lassiter emphasized how the group's open-mindedness and willingness to learn from each other was crucial.
"When you bring different people together, everybody brings their past experiences and concerns," she said. "One thing I appreciated about this group was that we were open-minded to each other and learning about each other."
The project's impact continues through institutional changes, with healthcare organizations incorporating HCAST's education and processes into their policies. Most importantly, survivors report feeling more comfortable seeking medical care after being involved with or learning about the project.
"What I really want to see continue is survivors being comfortable going in for healthcare," said Dr. Lassiter. "Many changed their minds about seeking medical care after being involved in the project. I'd like to see them always view the medical profession as an ally."
Through thoughtful collaboration and a commitment to creating lasting change, the HCAST project has helped build a more supportive healthcare environment for trafficking survivors in Wisconsin. While the AHW-funded portion has concluded, its resources and relationships continue to generate a positive impact throughout the community.