The UAB School of Nursing is an established leader in education, practice and policy related to trauma and trauma-informed care. Since 2016, the School has combined the nursing, forensic, and legal sciences to bring safety, medical treatment and justice to patients who have suffered various forms of trauma through its education, practice and research programs. It now leads a multidisciplinary partnership addressing issues such as human trafficking, intimate partner violence, domestic violence, sexual exploitation and trauma-informed care.

Spearheaded by Dr. Ashley Hodges who is known nationally for her work in trauma-informed care with victims of violence, the School has partnered with local, state and federal agencies, nonprofit organizations, as well as colleagues across the university and health system with expertise in the different aspects of interpersonal violence to harnesses the expertise of leaders in education, health care, criminal justice and policy to develop coordinated approaches to identify initiatives that meet the needs of victims and survivors.

An individual’s trauma experience impacts every part of their life – physical, mental and behavioral health as well as and social interactions. Trauma informed care emphasizes physical, psychological, and emotional safety, and creates opportunities for survivors to rebuild a sense of control and empowerment.

It involves understanding, recognizing, and responding to the effects of all types of trauma in multidisciplinary health care delivery that avoid judgment, as well as anticipating and avoiding institutional processes and individual practices that could be potentially retraumatizing, allowing patients to feel safe and supported. It also emphasizes the importance of patient participation in the development, delivery and evaluation of their health care services.

Human sex trafficking is the recruitment, harboring, transportation, provision, or obtaining of a person for a commercial sex act, in which a commercial sex act is inducted by force, fraud, or coercion. While the prevalence of female sex trafficking in the United States is underestimated due to the illegal nature of the issue, we do know that individuals of all genders, ethnicities, ages, and races are being sold for sex against their will in all 50 states and District of Columbia.

Healthcare providers are in a unique position and may be the only professional a trafficked individual interacts with during trafficking. Studies have demonstrated that as high as 88% of trafficked persons interact with health care providers while they are still being trafficked. Most of these individuals are not identified during the visit. Barriers to screening, identification, treatment, and referral are primarily because most health care providers receive little to no training in trafficking.

The lack of training leads to clinicians’ lack of comfort or familiarity with trafficking as a growing public health problem, identifying trafficked individuals in the health system, medical sequelae, and referral and reporting guidelines or requirements. In recognition of the importance of medical education on trafficking, multiple medical and nursing professional organizations and societies have called for academics and providers to change the current status of education.

Intimate partner violence/domestic violence describes physical violence, sexual violence, stalking or psychological harm by a current or former partner or spouse. It does not require sexual intimacy and occurs across all cultures, ethnicities, socioeconomic classes, and educational backgrounds, and is found among both heterosexual or same-sex couples.

Physical injuries happen to approximately 41% of female survivors and 14% of male survivors. But, interpersonal violence also extends beyond physical injury and can result in death. Crime data suggests that about 1 in 6 murder victims in the U.S. are killed by an intimate partner, and that more than 40% of female homicides are attributable to intimate partner violence. The patterns, dynamics, and consequences of intimate partner violence are complex and vary within and across individuals, relationships, and sociocultural contexts.

Health care providers are in a key position to implement successful intimate partner violence/domestic violence interventions. Successful interventions require multidisciplinary, trauma informed care embracing survivors medical and psychological needs, either short or long term.

UAB Clinic at The Wellhouse

Providing the Best Care

The WellHouse - School of Nursing Clinical Partnership is meeting a crucial need in the lives of women who are escaping the bonds of human trafficking. In 2018, The WellHouse and School of Nursing partnered to pilot the country’s first and only primary care clinic located inside a residential facility for human trafficking victims over the age of 17. The WellHouse - UAB School of Nursing Clinic, overseen by nurse practitioner Dr. Ashley Hodges, professor and associate dean in the UAB School of Nursing, provides residents with free, onsite evidence-based, trauma-informed primary and women’s health care, integrated with behavioral health. Through the clinic, WellHouse residents have direct access to not only Dr. Hodges but also a team of UAB specialists who are working together to address their health care needs.

These medically fragile women have a number of complex physical and mental health issues to overcome on their path to wellness -- yet until The Well House - UAB School of Nursing Clinic opened -- lacked access to coordinated care. Dr. Hodges applies the most current standards of trauma-informed care and builds trust with her patients, positioning and encouraging Well House residents to take ownership of their health and become engaged in their treatment. Together, they make important decisions about adjustments to prescribed medications, determine priorities and wellness goals, and create personalized plans of care. By measuring patient progress and outcomes, Dr. Hodges can determine best practices and deliver the best possible care.

An Impactful Partnership

As a result of The WellHouse - SON Clinical Partnership, Dr. Hodges has refocused her scholarly work to assist adult victims and survivors of human trafficking and develop new models of care for this vulnerable population. Over the past several years, Dr. Hodges has helped to increase awareness of the human trafficking crisis across the UAB campus and Birmingham community. She has educated more than 400 UAB and community health care providers, calling them into action to help identify and assist victims who enter area clinics and hospitals. She has also presented to national and regional groups working to combat human trafficking and assist adult victims and survivors.

As UAB launches a comprehensive initiative to address the problem of human trafficking and provide evidence-based care for victims across the life span continuum, the SON is playing a vital role by leading community-based outreach and translational research to connect victims with evidence-based care. The foundation for this expanding work is built upon The WellHouse - SON Clinical Partnership. This evidence-based model of care Dr. Hodges has created is one that can be replicated around the world to help the millions of victims of this international crisis each year.

The Ripple Effect

Dr. Hodges is leveraging new knowledge gained from the Well House Clinic to better understand the human trafficking crisis, and advocate for and better meet the highly complex health care needs of its victims. As a PhD prepared nurse scientist, Dr. Hodges is keenly aware that outcomes from The WellHouse Clinic and feedback from her patients can be translated into new applications that have the potential to help all adult victims of human trafficking.

Dr. Hodges is working to develop, implement and evaluate standards-of-care for victims, a screening tool for health professionals, and new curriculum and standardized-patient simulation. In January 2019, she received a small University of Alabama Health Services Foundation grant to begin curriculum development and standardized patient simulation. The goal is for students to have greater awareness of and be armed to fight against human trafficking so they are able to better care for victims upon graduation.

Outcomes (as of July 31, 2019):

The clinic has served 74 unique patients, ranging in age from 18 to 53, through 485 patient visits.

Improved health outcomes include increased self-care, management and reduction of drug use, and accurate diagnosis and treatment of mental conditions.

The clinic has resulted in reduced staff/volunteer time and expense for The WellHouse.

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