Human Trafficking

Human Trafficking

Position Statement

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It is the position of the National Association of School Nurses (NASN) that prevention, early identification, and intercession on behalf of the child/youth beset by human trafficking are essential to the student’s psychological and physical well-being, as well as academic success. The registered professional school nurse (hereinafter referred to as school nurse), utilizing astute clinical skills, is well-positioned to recognize signs and symptoms exhibited by a child/youth ensnared within the grooming/human trafficking process. Working in partnership with the school community, law enforcement, child protective services, community-based providers and social services, the school nurse serves a pivotal role by increasing public awareness of human trafficking and assisting with developing protocols for intervention.


Human trafficking, also termed trafficking-in-persons (TIP), and modern-day slavery is a multi-billion dollar per year criminal industry that involves exploiting a human being for labor, services, or commercial sex (U.S. Department of State Trafficking in Persons Report, 2020). It is a heinous global health crisis violating human rights (United Nations Office on Drugs and Crime [UNODC], 2020). The Trafficking Victims Protection Act of 2000 defines human trafficking as:

  • Sex trafficking in which a 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; or
  • Forced labor which is 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.

The Office of Juvenile Justice and Delinquency Prevention (2021) terms sex trafficking of children as Commercial Sexual Exploitation of Children (CSEC). CSEC comprises the commercial sex industry and coerced employment in sexualized jobs. Sexual exploitation includes survival sex - trading sexual acts for shelter, food, or drugs (Costa, 2019). The threat for sex trafficking is highest when both individual risk factors and societal challenges meld in a young person’s life, including poverty, homelessness, a history of maltreatment, low educational attainment, migration, identifying as gender nonconforming or sexual minority, lack of work opportunities, lack of family support, lack of connection to caring adults, and in the United States specifically, English as a second language (Miller-Perrin & Wurtele, 2017; Moore et al., 2017; Toney-Butler et al., 2021; UNODC, 2020).

Within the United States, TIP has been reported in all 50 states (National Human Trafficking Hotline [NHTH], 2019). There has been increasing recognition of a previously unidentified population of children who are US citizens/residents and have fallen prey to sex trafficking, accordingly, identified as Domestic Minor Sex Trafficking (DMST) (Moore et al., 2017). TIP including DMST permeates all communities, socioeconomic groups, and student demographics (National Center of Safe Supportive Learning Environments, 2020), albeit women and girls are disproportionately affected (UNODC, 2020). Any person, regardless of gender, race or age, may succumb to human trafficking (NHTH, 2019). Major victim risk factors driving the trafficking industry are poverty, social injustice, natural disasters, substance abuse, family breakdown, and homelessness (Okech et al., 2018; UNODC, 2020; Wolfe et al., 2018).

LGBTQ individuals are most vulnerable to DMST due to experiencing higher rates of adverse childhood experiences versus their cis-gender counterparts (Toney-Butler et al., 2021). LGBTQ youth face considerable challenges including discrimination, misconceptions, and abuse by peers, family members and the community (Polaris Project, 2016). This subset of youth is at highest risk of being targeted by traffickers if homeless as compared to other homeless youth (National Coalition for the Homeless, 2020). Forty percent of homeless youth identify as LGBTQ and are more likely to engage in survival sex to meet basic needs such as shelter, food, toiletry and medication (Polaris Project, 2016). Minors engaged in commercial sex are considered to be trafficking victims regardless of the use of force, fraud, or coercion (Rothman et al., 2017).

Schools are one of the many settings traffickers use to recruit children (National Center on Safe, Supportive Learning Environments, 2020). The trafficker may in fact be another student (Toney-Butler et al., 2021). Social media websites, chat rooms, after-school programs, and house parties are other venues traffickers exploit to accrue victims (Moore et al., 2017; Toney-Butler et al., 2021; UNODC, 2020).

Signs of child trafficking at minimum may include unexplained absences, poor attendance, runaway behavior, boasting about frequent travel to other cities, inappropriate dress for the current weather, hunger, malnourishment, falling asleep in class, impairment from drugs and/or alcohol, poor compliance with general medical or dental care, and transitory lifestyle (Moore et al., 2017; Toney-Butler et al., 2021). Negative health consequences may involve neurologic, gastrointestinal, cardiovascular, musculoskeletal, dermatological, reproductive, sexual, dental, and mental health problems (Rothman et al., 2017). Specifically, mental health disorders such as anxiety, depression, attempted suicide and life-threatening infections are manifestations of those exploited (Charteris et al., 2018; Cockbain et al., 2018; Hemmings et al., 2016; Henry & Grodin, 2018; Ottisova et al., 2016; Ottisova et al., 2018). Trafficked persons often seek medical services at some point during their exploitation (Schwarz et al., 2016), creating an opportune time for intervention.

School nurses and other specialized instructional support professionals are well positioned to help with identification of and intervention for this concealed crime. Schools strive to create a safety net for students by building healthy environments, ensuring student safety, promoting health, and assuring readiness to learn (NASN, 2017). School nurse assessment skills provide proactive surveillance critical to the identification of signs and symptoms associated with human trafficking. Effective response to child trafficking requires a clearly defined course of action, supported by collaboration with child protective services, law enforcement, social services, and community-based service providers (Moore et al., 2017).

Utilizing NASN's Framework for 21st Century School Nursing Practice™ (NASN, 2016) the school nurse, mobilizing the key principles of leadership and community/public health, serves as health expert for the school community to augment awareness of human trafficking by promoting education and assisting in the development of district protocols for identifying a suspected victim or responding to a disclosure from a victim. School nurses interact with children/youth daily. Understanding how TIP can manifest on school grounds as well as in the community is imperative for prevention, early recognition and intervention.


Charteris, A., German, C., Hansrani, Z., Li, E., & Merchant, J. (2018). Health at risk: Health implications of human trafficking in the context of globalization and migration. Juxtaposition Global Health Magazine, 13(1).

Cockbain, E., Bowers, K., & Dimitrova, G. (2018). Human trafficking for labour exploitation: The results of a two-phase systematic review mapping the European evidence base and synthesizing key scientific research evidence. Journal of Experimental Criminology, 14(3), 319-360.

Costa, C. B., McCoy, K.T., Early, G. J., Deckers, C. M. (2019). Evidence-based care of the human trafficking patient. Nursing Clinics of North America, 54, 569–584.

Hemmings, S., Jakobowitz, S., Abas, M., Bick, D., Howard, L.M., Stanley, N., Zimmerman, C., & Oram, S. (2016). Responding to the health needs of survivors of human trafficking: A systematic review. BMC Health Services Research, 16(1).

Henry, A. M. L., & Grodin, M. A. (2018). Human trafficking: A health and human rights agenda. Annals of Internal Medicine, 168(9), 674–675.

Miller-Perrin, C. & Wurtele, S. K. (2017). Sex trafficking and the commercial sexual exploitation of children. Women & Therapy, 40(1-2), 123-151.

Moore, J. L., Kaplan, D. M., & Barron, C. E. (2017). Sex trafficking of minors. Pediatric Clinics of North America, 64, 413–421.

National Association of School Nurses. (2016). Framework for 21st century school nursing practice. NASN School Nurse, 31(1), 46-53.

National Association of School Nurses. (2017). Whole schools, whole community, whole child: Implications for 21st century school nurses.

National Center on Safe Supportive Learning Environments. (2020). Human trafficking in America’s schools.

National Coalition for the Homeless (2020). Youth Homelessness. National Human Trafficking Hotline (NHTH). (2019). 2019 U.S.

National Human Trafficking Hotline Statistics.

Office of Juvenile Justice and Delinquency Prevention (OJJDP) (2021). Commercial sexual exploitation of children.

Okech, D., McGarity, S. V., Hansen, N., Burns, A. C., & Howard, W. (2018) Financial capability and sociodemographic factors among survivors of human trafficking. Journal of Evidence-Informed Social Work, 15(2), 123-136.

Ottisova, L., Hemmings, S., Howard, L. M., Zimmerman, C., & Oram, S. (2016). Prevalence and risk of violence and the mental, physical, and sexual health problems associated with human trafficking: An updated systematic review. Epidemiology and Psychiatric Sciences, 25(4), 317–341. https://doi:10.1017/S2045796016000135 

Ottisova, L., Smith, P., Shetty, H., Stahl, D., Downs, J., & Oram, S. (2018). Psychological consequences of child trafficking: An historical cohort study of trafficked children in contact with secondary mental health services. PLoS ONE,13(3):e0192321. https://doi:10.1371/journal.pone.0192321.

Polaris Project. (2016) Sex trafficking and LGBTQ+.

Rothman, E. F., Stoklosa, H., Baldwin, S. B., Chisolm-Straker, M., Price, R. K., Atkinson, H. G. and on Behalf of HEAL Trafficking. (2017). Public Health Research Priorities to Address US Human Trafficking. American Journal of Public Health, 107, 1045-1047.

Schwarz, C., Unruh, E., Cronin, K., Evans-Simpson, S., Britton, H. & Ramaswamy, M. (2016). Human trafficking identification and service provision in the medical and social service sectors. Health and Human Rights Journal, 18(1):181–89.

The Trafficking Victims Protection Act of 2000 (22 U.S.C. § 7102(9)).

Toney-Butler, T. J., Gossman, W., & Mittel, O. (2021). Human trafficking. In StatPearls. Treasure Island, FL.

United Nations Office on Drugs and Crime (UNODC). (2020). Global report on trafficking in persons. United Nations, New York.

U.S. Department of State (2020). Trafficking in persons report, 20th ed.

Wolfe, D. S., Greeson, J. K. P., Wasch, S. & Treglia, D. (2018). Human trafficking prevalence and child welfare risk factors among homeless youth: A multi-city study. The Field Center for Children’s Policy, Practice & Research, University of Pennsylvania, January, 1-60.

Acknowledgment of Authors:

Gina Emge, MSN, RN, NJ-CSN
Janet Thornton, MSN Ed., BSN, RN
Sharon L. Bailey, MSN, RN
Lisa Kern, MSN, RN, NCSN
Linda Neumann, RN
Patrice Lambert, MSN, RN, SNC
Brenda Lindahl, RN
Elizabeth McDermott, BSN, RN, NCSN
Susan Morgan, MEd, RN, NCSN

Adopted: June 2021

This position statement replaces the position brief titled Human Trafficking: Implications for 21st Century School Nurses.

Suggested citation: National Association of School Nurses. (2021). Human Trafficking [Position Statement]. Silver Spring, MD: Author.

“To optimize student health, safety and learning, it is the position of the National Association of School Nurses that a professional registered school nurse is present in every school all day, every day.”

All position statements from the National Association of School Nurses will automatically expire five years after publication unless reaffirmed, revised, or retired at or before that time.