A roll of red circle stickers hangs from a box on a bathroom wall. On the wall beside the stickers are two signs, one in English and one in Spanish, describing to patients how to apply the sticker to a urine sample cup if they have experienced abuse. Photo courtesy of Ami Mitchell.

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Human Trafficking Intervention Developed in an SPH Classroom Gains Traction

Students in Jacey Greece’s spring 2024 communications course collaborated with the Tennessee Department of Health on an initiative to encourage victims of abuse to disclose their circumstances to healthcare providers. Following a yearlong pilot in the Chattanooga region, the success of the campaign led to a new partnership with a county health department in West Virginia this semester.

During a spring 2024 communications strategies course with Jacey Greece, clinical professor of community health sciences, students from the School of Public Health designed an innovative intervention to encourage victims of abuse to disclose their circumstances to healthcare providers.

Tasked with helping the Tennessee Department of Health (TDH) to increase detection of human trafficking, the students developed an awareness campaign and discrete disclosure mechanism for the department’s health clinics. The initiative, titled “Red Dot to Disclose,” empowers victims to privately alert their providers to abuse by placing a red sticker on their urine specimen cup before depositing it in a secure collection box within the restroom wall. Signs created by the students to explain the system in both English and Spanish were then piloted in the restrooms of TDH clinics across the Chattanooga region.

Word of mouth has proven a powerful force in seeding academic-community partnerships, such as that between Greece’s students and a team led by Ami Mitchell, South Central regional director at TDH. In 2020, Greece began publicly documenting the impact of practice-based teaching (PBT), creating Collaborate.Health with James Wolff, adjunct associate professor of global health, to showcase student projects and their outcomes. To date, SB806 and other SPH courses centering PBT have completed more than 150 projects across 18 countries for dozens of public health partners.

During spring 2026, the Cabell-Huntington Health Department in West Virginia is partnering with Greece for the first time after hearing her and Mitchell present on Red Dot to Disclose at a National Association of County Health Officials conference. Last week, Greece’s Designing Strategic Interventions and Communications to Advance Public Health (SB806) students presented the Cabell-Huntington team with three new proposals for how they might tackle human trafficking, given the results of Red Dot to Disclose in Tennessee.

“These victims are speaking up,” says Greece. “In Tennessee, the program is doing what it designed to do. Is it doing it accomplishing the outcomes in the exact way we planned? No. Victims are not using the red dots. But the intention was threefold: raise awareness about trafficking; tell the victim that what’s happening to them is not right; and create a safe space for them to disclose to clinic staff. Disclosure is still happening—which means awareness and empowerment is happening—even without the red dot. Now, we can take that information, adapt it to West Virginia, and give them the most appropriate, high-quality intervention that positively changes outcomes.”

Mitchell agrees, confirming that the Red Dot to Disclose initiative has not worked the way she and the students imagined it would, but she is convinced the campaign works in other ways.

“Since we have concentrated on ways to make patients feel safer in our clinics, we have had more disclosures of abuse, especially trafficking,” Mitchell says. She believes there are advantages to leaving the Red Dot signs up in clinic restrooms, even if patients are not using the red dot system.

“[The sign] reinforces the message that we want to keep you safe and we can be trusted,” she says. “A patient may not be able to disclose on the day they are in clinic because of who is with them or due to fear. But we have seen them come back in, ask to see the same nurse and then they disclose.”

Since the signs were installed, Mitchell is aware of two instances where patient disclosures have led to arrests. She is uncertain how many patients in total have come forward, but she knows it happens regularly.

Mitchell would like to gather more than just anecdotal evidence of the importance of the campaign, she says, but TDH does not have the funding to conduct a third-party evaluation. According to Greece, traditional monitoring and evaluation techniques would also likely be difficult to implement given the discretion needed to protect victims.

In the past, Greece has been able offer her expertise to support partners seeking to evaluate interventions translated from student proposals, and she has often maintained relationships with her partners long after their collaboration in the classroom has come to an end.

The School’s Online MPH program, for example, also leverages Greece’s approach to practice-based teaching to provide students a virtual-friendly alternative to the traditional practicum. During the program’s fifth module, the students partner with an outside organization to tackle real-world public health problem. That module is co-taught by Greece and Meredith Hurley, the director of public health at the Winthrop Department of Public Health & Clinical Services, sustaining a partnership Greece and Hurley first launched nearly a decade ago when Greece’s students consulted on Winthrop’s internationally renowned Community & Law Enforcement Assisted Recovery (CLEAR) program.

With ongoing help from Greece, evaluation of Winthrop’s CLEAR program has produced evidence of the effectiveness of the program in reducing opioid overdose fatalities by connecting people to mental health and substance use disorder treatment, and its success was recently featured by NBC Boston.

To learn more about the inception of the Red Dot to Disclose initiative, click the following link to read our original coverage of the classroom project: Red Dot to Disclose: Students Inform Intervention to Help Victims of Abuse.