{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T11:40:32Z","timestamp":1786621232032,"version":"build-2736575974"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:p>Human trafficking is a major public health and human rights concern associated with high rates of psychiatric disorders, substance use disorders, chronic medical illness, and ongoing exposure to trauma. Patients frequently encounter healthcare systems while still experiencing exploitation, yet trafficking often goes unrecognized. Healthcare professionals are uniquely positioned to identify trafficking and facilitate access to recovery-oriented services. This manuscript describes the development and content of a trauma-informed healthcare response protocol designed to guide Alabama clinicians in identifying and supporting survivors of human trafficking. The protocol was developed through interdisciplinary collaboration among experts in psychiatry, psychology, emergency medicine, pediatrics, social work, and law, alongside engagement with community-based anti-trafficking organizations. It integrates national best-practice guidance with state-specific legal requirements and resource networks to support clinicians in responding to suspected trafficking in a trauma-informed and legally informed manner. Key components of the protocol include identification of clinical indicators of labor and sex trafficking, trauma-informed interviewing practices, structured screening and assessment approaches, safety planning strategies, and multidisciplinary referral pathways involving social work, psychiatric services, legal advocates, and community partners. The protocol also provides guidance regarding trauma-informed documentation practices, medical record safety considerations, and mandatory reporting requirements under Alabama law. Although developed within a specific legal and healthcare context, the protocol illustrates the importance of integrating local laws, institutional practices, and resource networks into trafficking-response frameworks. Its core principles of trauma-informed screening, multidisciplinary collaboration, and medical\u2013legal coordination may be broadly adaptable across healthcare systems.<\/jats:p>","DOI":"10.3389\/fpsyt.2026.1885986","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T11:24:16Z","timestamp":1786620256000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["An Alabama-tailored human trafficking response protocol within the Community, Advocacy, Law, and Medicine framework: a state-adaptable model"],"prefix":"10.3389","volume":"17","author":[{"given":"Cassie","family":"Wicken","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham","place":["Birmingham, AL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luke","family":"Frazier","sequence":"additional","affiliation":[{"name":"Love Immigration Law Firm","place":["Birmingham, AL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marquita","family":"Brooks","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of Alabama at Birmingham","place":["Birmingham, AL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen","family":"Eaton","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham","place":["Birmingham, AL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hammond","family":"Lake","sequence":"additional","affiliation":[{"name":"Human Resources Communications, University of Alabama at Birmingham","place":["Birmingham, AL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kara S.","family":"Huls","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Alabama at Birmingham and Children\u2019s of Alabama","place":["Birmingham, AL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Rampe","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham","place":["Birmingham, AL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsey Baird","family":"Moultrie","sequence":"additional","affiliation":[{"name":"The University of Alabama at Birmingham Lister Hill Library","place":["Birmingham, AL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Macaluso","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham","place":["Birmingham, AL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aniket","family":"Malhotra","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham","place":["Birmingham, AL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Fargason","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham","place":["Birmingham, AL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham","place":["Birmingham, AL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.neuropsych.20240175","article-title":"Neuropsychiatric vulnerabilities and sequelae of human trafficking in the United States","volume":"37","author":"Gordon","year":"2024","journal-title":"J Neuropsychiatry. Clin Neurosci"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2022-060416","article-title":"Exploitation, labor and sex trafficking of children and adolescents: Health care needs of patients","volume":"151","author":"Greenbaum","year":"2023","journal-title":"Pediatrics"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1080\/08964289.2018.1432551","article-title":"A comparison of psychological symptoms in survivors of sex and labor trafficking","volume":"44","author":"Hopper","year":"2018","journal-title":"Behav Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1177\/1363461520983950","article-title":"Treatment considerations for foreign-born victims of human trafficking: Practical applications of an ecological framework","volume":"58","author":"Salami","year":"2021","journal-title":"Transcultural. Psychiatry"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.chiabu.2019.104137","article-title":"Barriers to the access and utilization of healthcare for trafficked youth: A systematic review","volume":"100","author":"Garg","year":"2020","journal-title":"Child Abuse Negl"},{"key":"B6","volume-title":"Global Estimates of Modern Slavery: Forced Labour and Forced Marriage","year":"2022"},{"key":"B7","first-page":"28","article-title":"Specialized care for immigrants experiencing trauma is vital. Psychologists are breaking down the mental health barriers","volume":"54","author":"Moncrieffe","year":"2023","journal-title":"Monitor. Psychol"},{"key":"B8","volume-title":"Global Report on Trafficking in Persons 2024","year":"2024"},{"key":"B9","volume-title":"Polaris Analysis of 2021 Data From the National Human Trafficking Hotline","year":"2022"},{"key":"B10","volume-title":"Current and Future Research on Labor Trafficking in the United States","author":"Eyerman","year":"2023"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1353\/hpu.2016.0131","article-title":"Health care and human trafficking: We are seeing the unseen","volume":"27","author":"Chisolm-Straker","year":"2016","journal-title":"J Health Care Poor. Underserved"},{"key":"B12","first-page":"61","article-title":"The health consequences of sex trafficking and their implications for identifying victims in healthcare facilities","volume":"23","author":"Lederer","year":"2014","journal-title":"Ann Health Law"},{"key":"B13","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1093\/oso\/9780195391206.003.0006","article-title":"Identification of human trafficking victims in health care settings","volume":"13","author":"Baldwin","year":"2011","journal-title":"Health Hum Rights"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1002\/emp2.12558","article-title":"Validation of a screening tool for labor and sex trafficking among emergency department patients","volume":"2","author":"Chisolm-Straker","year":"2021","journal-title":"J Am Coll Emerg Physicians. Open"},{"key":"B15","volume-title":"Understanding and Improving Law Enforcement Investigations of Human Trafficking: Focus on Labor Trafficking","author":"Peterka-Benton","year":"2024"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1177\/00333549211059833","article-title":"Creating a collaborative trauma-informed interdisciplinary citywide victim services model focused on health care for survivors of human trafficking","volume":"137","author":"Jain","year":"2022","journal-title":"Public Health Rep"},{"key":"B17","volume-title":"Qualitative Research & Evaluation Methods","author":"Patton","year":"2015"},{"key":"B18","unstructured":"DHS Center for Countering Human Trafficking, Continued Presence\n          \n          2025"},{"key":"B19","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1097\/PRA.0000000000000287","article-title":"Psychiatry\u2019s role in the management of human trafficking victims: An integrated care approach","volume":"24","author":"Gordon","year":"2018","journal-title":"J Psychiatr Pract"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.201500509","article-title":"Self-harm among adult victims of human trafficking who accessed secondary mental health services in England","volume":"68","author":"Borschmann","year":"2017","journal-title":"Psychiatr Serv"},{"key":"B21","volume-title":"In Harm\u2019s Way: How Systems Fail Human Trafficking Survivors","year":"2023"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.58464\/2155-5834.1231","article-title":"Understanding victim resistance: An exploratory study of the experiences of service providers working with victims of child trafficking","volume":"6","author":"West","year":"2015","journal-title":"J Appl Res Children"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002144","article-title":"Identifying and assisting sexually exploited and trafficked patients seeking women's health care services","volume":"130","author":"Tracy","year":"2017","journal-title":"Obstet. Gynecol"},{"key":"B24","volume-title":"Human Trafficking on Temporary Work Visas","year":"2019"},{"key":"B25","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1001\/journalofethics.2017.19.1.msoc2-1701","article-title":"Caring for the trafficked patient: Ethical challenges and recommendations for health care professionals","volume":"19","author":"Macias-Konstantopoulos","year":"2017","journal-title":"AMA. J Ethics"},{"key":"B26","volume-title":"Adult Human Trafficking Screening Tool and Guide","author":"Macias-Konstantopoulos","year":"2018"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1093\/jamia\/ocaf220","article-title":"Identifying and supporting trafficked individuals: Provider and community organization perspectives on existing sociotechnical approaches","volume":"33","author":"Gomez","year":"2026","journal-title":"J Am Med Inform Assoc"},{"key":"B28","volume-title":"Trauma-Informed Practice in the Field: Recommendations for Human Trafficking Service Providers","author":"Chakoian","year":"2021"},{"key":"B29","unstructured":"Identifying Victims of Human Trafficking: What to Look for During a Medical Exam\n          \n          2016"},{"key":"B30","volume-title":"Protocol Toolkit for Developing a Response to Victims of Human Trafficking","author":"Baldwin","year":"2017"},{"key":"B31","volume-title":"Safe and Effective Documentation","year":"2021"},{"key":"B32","volume-title":"Human Trafficking and Health Care Providers: Lessons Learned From Federal Criminal Indictments and Civil Trafficking Cases","author":"Bessell","year":"2017"},{"key":"B33","unstructured":"Who is Eligible"},{"key":"B34","unstructured":"Engage Together Alabama Resource Directory\n          \n          2026"},{"key":"B35","unstructured":"Programs and Services"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1885986\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T11:24:22Z","timestamp":1786620262000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1885986\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,13]]},"references-count":35,"alternative-id":["10.3389\/fpsyt.2026.1885986"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2026.1885986","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,13]]},"article-number":"1885986"}}