The Creation of a Human Trafficking Course: Interprofessional Collaboration from Development to Delivery

Human Trafficking is a serious global crime, particularly catastrophic in Africa. An asynchronous, online, interprofessional course on Human Trafficking was developed to educate interprofessional Catholic sisters in Africa who are attempting to intervene in the crisis. This article describes an interprofessional university team’s development, work processes, course product, and the initial impacts of the utilization of the interprofessional skills by the students. Specific elements deemed essential for success in creating and implementing IPE are delineated, including commitment from departments and colleges, respect for other professionals/disciplines, library support, time allowances, technology and learning design, and community relationships. Challenges and recommendations in the process as well as suggestions for future research are also discussed.

families, and communities sustain serious short and long-term consequences from trafficking. Victims present with a wide variety of biological, psychological, social, and spiritual symptoms, and interface with many different organizations, such as healthcare agencies, social services, addictions services, child welfare agencies, spiritual organizations, legal services, and schools. They also interact with varied professionals, like doctors, nurses, teachers, social workers, spiritual leaders, judges, and police officers. However, many times, they are not recognized as victims of trafficking (Hargreaves-Cormany & Patterson, 2016). In order to effectively identify, assess, intervene, and eradicate human trafficking, multiple professions need to be fully informed and work collaboratively. This requires training and education that is comprehensive, interprofessional in nature, and provides opportunities for multiple professions of students to interact, network and partner.
Interprofessional education (IPE) is still rare in academia due to academia's history, culture, and organization (Olenik et al., 2010). For instance, academia has traditionally been organized to provide degrees or majors, with varying silos of disciplines ready to deliver these. Separate colleges and departments reinforce these silos. Except for the health disciplines, which embraced the philosophy and practice of interprofessional education years ago, the culture of academia has often dismissed the value of interprofessional education and reinforced competition between departments and professions rather than collaboration among them (Gilbert, 2005). For instance, departments must compete against one another over the same students and departments or majors with low enrollment are eliminated.
As a result, many resources are expended to create and deliver interprofessional courses or programs. Multiple faculty members are required to create one course and employing a large staff team from various university departments generates large expenses in time and financial resources. Additional barriers, such as the assignment of credit or pay for the creation or teaching of an IPE course, cause faculty to avoid the endeavors. The university processes result in fewer IPE, which is unfortunate because universities may miss opportunities to address the needs of the current workforce: Employers typically expect graduates to think creatively, critically, and interprofessionally. In addition, these traditions discourage students from thinking broadly beyond their own discipline to solve complex problems or work collaboratively and efficiently with other professions (Schaefer & Larkin, 2015). The eradication of social problems requires unique skills, creativity and interprofessional thinking and action.
Studies on interprofessional education have shown positive outcomes for students, including improved collaboration and cooperation with other professions, increased respect for other professions, and improved attitudes toward teamwork (Barr et al., 2005;WHO, 2010;Zucchero et al., 2010). Suiter and colleagues (2015) found an increase in students' knowledge and practice-based competencies after completion of an interprofessional practice-based course. Most studies to date have been focused on interprofessional health care education and practice and further research is needed to clearly understand the benefits of other interprofessional educational programs (Schaefer & Larkin, 2015).
Social work education has not advanced much further on this undertaking even though social workers engage in interprofessional work more often than not (Mosser & Begun, 2014). Besides field practicum assignments or additive IPE assignments in courses, there are few examples of IPE courses described or evaluated (Schafer & Larkin, 2015). Yet, social work students could greatly benefit and be better prepared for their professional practice by interacting and understanding how other professionals think and work.

Current Article
This article examines two aspects of interprofessional education related to the development and implementation of a human trafficking course. First, we describe the interprofessional team's development processes, the interprofessional nature of the students intended to enroll in the course, and the final developed course product. Second, we provide insight into how the Catholic sisters who have taken this course plan to use the knowledge and skills they have gained to address human trafficking by engaging in interprofessional practice in their communities. In addition, we discuss specific elements deemed essential for success in creating IPE: the need for commitment from departments and colleges, respect for other professionals/disciplines, library support, time allowances, technology and learning design, and community relationships. Finally, we discuss challenges and recommendations for undertaking this type of endeavor.

Method Development Processes
The project was funded by a grant from the Conrad N. Hilton Foundation, which supported course development, course delivery, and evaluation. The intent of the grant was to specifically upskill Catholic Sisters in Africa regarding Human Trafficking. The development team from Saint Leo University consisted of social work, sociology, and criminal justice faculty members, a librarian, a learning designer, and a Catholic sister alumna from Africa. Social workers possess knowledge and skills which directly relate to the problem of human trafficking but also make them natural team leaders. In this project, two social work professors led an interprofessional team to create an innovative, microcredential (not for college credit), online course to specifically educate an interprofessional group of Catholic sisters working in countries throughout Africa. The Catholic sisters were part of the Talitha Kum network, an international and interprofessional network of Catholic sisters dedicated to ending human trafficking. Sisters are expected to educate communities, develop prevention programs, network, advocate for policy changes, and intervene at micro, meso, and macro levels to eradicate human trafficking. The sisters generally receive brief webinars and workshops on human trafficking, but these are focused on teaching basic knowledge and are usually not competency based. For example, sisters are not well versed in trauma-informed practices, conducting assessments, interviewing, practice, networking, and advocacy skills, or developing programs.
First, course objectives were delineated based on the grant requirements and the needs of the sisters belonging to the Talitha Kum network. Next, a curriculum map was used to identify content and skills from current courses offered by Saint Leo University.
Curriculum mapping is an evidence-based approach to curriculum assessment and development, which helps educators align content, skills, and standards for a course (Arafeh, 2016). In this case, a list of learning outcomes and associated course activities across various social work and criminal justice courses were developed to identify content and skills that were already being taught. Some of the identified activities, readings, and assignments were then deconstructed from already developed courses and adapted for the Human Trafficking course. At that stage, the librarian used her knowledge of the available resources to assist in finding appropriate content, references on African cultures, statistics, and government policies for the course. In addition, an alumna of the university who is a Catholic sister from Africa educated faculty about African cultures and the culture of Catholic sisters. All resources, cases, images, and local contextual knowledge were then incorporated into to the course. Once the syllabus was complete, the coordinator of the Talitha Kum network reviewed the content and provided recommendations, which were incorporated into the course.
Then, a learning designer who worked exclusively on our course was introduced to the team, course content, and syllabus. His task was to create online modules and visuals, based on the content and direction from the faculty. Online modules were checked every week and modified as necessary. Assignments were checked and re-checked, including the coordinator of Talitha Kum, who reviewed the online content and made recommendations, to ensure the best possible fit with the target population.

Students
The students for this course were Catholic sisters who lived and worked in various countries across Africa. They all had a bachelor's degree in varying disciplines and their professions and roles were highly diverse, including but not limited to administrators, educators, psychologists, accountants, nurses, and social workers. For most of the students, English was a second, third, or fourth language. Often, access to technology was limited. The sisters had all interfaced with human trafficking, either through working with victims, seeing trafficked individuals in their towns, or hearing about citizens being lured from their villages into trafficking situations. They were deeply motivated to gain knowledge and skills to prevent and address human trafficking in their regions.

Course Product
The purpose of the course was to provide an opportunity for Catholic sisters to develop new skills and the knowledge and competencies required to interfere with human trafficking in Africa, and to encourage sisters to work interprofessionally. The asynchronous, online course included 12 modules for students to learn to identify and understand consequences of human trafficking; apply trauma informed theories; conduct assessment; use practice skills; develop prevention strategies; and create and use networking and advocacy skills. Students worked together through one module per week, completing readings, watching videos, and working through quizzes and interactive exercises. In addition, they completed role-plays with colleagues online and in-person.
Two cases were used throughout the course for students to actively apply their learning. Each case study portrayed how a victim of human trafficking might evolve over time. These cases allowed students of different professions to understand how their profession and other professions intervene with the client and to learn skills beyond their profession, which would be effective in assisting a victim of human trafficking. Throughout the week, students interacted with one another through discussion boards and soon developed connections with one another. These connections soon led to collaborations, shared ideas, and networking with each other beyond the course, thus directly affecting their efforts to interfere with trafficking. Finally, students developed a training manual throughout the course to use for themselves and to train others upon completion of the course.

Sample
Forty-six Catholic sisters were enrolled and completed the course from Fall 2018 through Summer 2019. They were all serving in Africa, with most of them coming from Nigeria (45.65%), followed by Kenya (10.87%), South Africa (8.70%), and Uganda (8.70%). The rest were working across various other countries (see Table 1 for full details). The mean age of the sisters was 44.34 (SD = 11.81). In terms of current occupation, the largest proportion worked as educators (28.57%), followed by program coordinators (14.29%), counselors (14.29%), and direct community practice workers (11.90%). A full list of the professions can be found in Table 2. No racial/ethnic demographics were collected.

Analysis
The Saint Leo University IRB approved the study. A three-month post course, followup question asking the Sisters how they were using the course content in their work, in addition to the end-of-course training manual assignment and the discussion posts from the weekly course discussions, were also included in the analysis. Responses were coded for types of activities planned; partners to be involved in the plans; plans to keep in touch with other students; and aspects of the course found to be useful. The goal was to examine how the course affected the sisters' interprofessional work and planned approach to addressing human trafficking.

Impact on Interprofessional Collaboration for Catholic Sisters
When asked about identifying intervention strategies they would employ and the implementation plan they created for their community, 86% (n=40) of sisters reported plans for various forms of networking and collaboration. Fourteen (30.4%) had already initiated various contacts. A few students reported specific action steps while others referred to a desire for greater cooperation. Likewise, some of the contacts they listed identified a specific organization or individual, even including a name, but others referred to a professional category or type of organization. Students may have discussed engaging more than one interprofessional group or organization in their action plans.
Almost half of the Sisters discussed making connections with nongovernmental organizations (45.7%; n=21). Another 37% (n=17) mentioned they planned to connect to other sisters in the course, 34.8% (n=16) planned to work with other catholic organizations, and 32.6% (n=15) discussed working with government agencies or officials. This was followed by grassroots groups (19.6%; n=9), traditional community leaders (17.4%; n=8), schools (13%; n=6) and even media organizations (13%; n=6). How the sisters planned to collaborate with these groups varied, but the most common planned activities were the creation of coalitions (36%; n=17), the dissemination of information gained from the course (34.8%; n=16), and the organization of meetings or visits (26.1%; n=9). Table 3 provides full details on how the students planned to engage others in addressing human trafficking. The students specifically identified other professions they would involve in addressing the issue of human trafficking in their local area. Their action plans most often mentioned spiritual leaders (80.43%; n=27), followed by school personnel, including teachers and administrators (58.70%; n=27), governmental representatives from the local to national levels (54.35%; n=25), and law enforcement personnel (54.35%; n=25). Other key professions and groups mentioned, included community members (leaders and members), medical personnel (doctors, nurses and health workers), family members, media (traditional and social), mental health professionals, legal personnel (judges, prosecutors and lawyers), and social workers. Table 4 provides full details on the number and percentage of professions that the sisters mentioned in their action plans. Through this course, sisters were able to create crucial connections to other sisters in Africa who are fighting Human Trafficking. They were eager to network with other sisters in the course who worked close by and/or could bring expertise from other countries. For instance, a couple of sisters in Mauritania who were tasked with creating a branch from their organization to address human trafficking were able to connect with coordinators from Ghana and Nigeria to give information on how to start developing anti-trafficking programs.
One-third of the students expressed a desire to establish continued communication with the other students in their cohort, ranging from establishing an online forum to meeting face-to-face. Many of the students were isolated, as they were the only ones addressing human trafficking in their region. One of the key benefits of this course was that the students were able to share ideas, tactics, and information with other students in different parts of Africa. This allowed the students to learn from one another. This was reiterated by one student who said: Discussing tactics for advocacy for human trafficking as a tool and networking with other organizations was a keynote that will remain in me to continue and bringing on board to work with others in fighting this vice. Having learned and been made aware that human trafficking is a global network/global issue and to deal with it I must also be in a network or work as a team in order to come to an end was a key study for me in this course.
The difficult task of working with the individuals, families, and communities victimized by human trafficking cannot be completed alone. Sisters developed an essential network with each other. They understand the stress and secondary trauma of this work and were able to support one another. At the end of the course, they asked faculty to create a spreadsheet of all students and their contact information to be shared. The faculty members have done so and have built on the list by adding each cohort's information as the course proceeds to be delivered. The list is shared with all students (after consent) upon completion of the course.
Finally, the students utilized their learning to develop a training manual based on their own region and its unique human trafficking issues. The manuals would be used by the sisters to train further trainers. Since each region is unique regarding available resources, dangers, advocacy groups, and services, participants developed their manual through community resource mapping, which included: identifying available services and gaps in services, identifying current and needed prevention efforts, specifying approaches to advocacy and networking, and determining safe connections. For instance, in some communities, police officers were an ally, but in others they may be involved in helping traffickers. The benefits of the assignment were noted in one student's comment:

The opportunity to review the services available for victims and their families in my region, and to assess what could be missing. I became more aware of the prevention measures for tackling human trafficking in Nigeria, such as shelter homes, the need for formation of coalition, advocacy, awareness creation, legal support, workshops and seminars, and working with government agencies.
The course, overall, inspired the participants to make plans to reach out to a very diverse set of agencies and professionals, from the local level to the international level. This interprofessional collaboration highlights the value of each participant's unique skillset and the need to work together across different types of agencies and professions in order to truly address human trafficking.

Discussion
The intent of this article is twofold: to describe the interprofessional team's development, processes, and interprofessional human trafficking course; and to provide results on the utilization of interprofessional practice upon completion of the course. The process of developing, delivering, and evaluating an interprofessional course provided many opportunities for learning. Following are some recommendations for others interested in pursuing IPE at their institution.
Sunguya and colleagues (2014) examined forty articles to identify common problems with developing IPE courses and how those lessons could be applied to developing countries. They found ten challenges across their study, including curriculum, leadership, resources, stereotypes, variety of students, IPE concepts, teaching, enthusiasm, professional jargon, and accreditation. In the development of the IPE course on human trafficking at Saint Leo University, many, though not all, of these issues emerged as well and had to be overcome. These included curriculum (working with learning design, engaging the library in course development, and developing community relationships), leadership (commitments at the university level), embracing IPE concepts (respect for the interprofessional approach), teaching (different departmental expectations and policies), and resources (understanding the impact of time).

Course Content
Barriers can occur with course content, structure of the course, and time for participants to adequately participate (Sunguya et al., 2014). In this case, working with technology and a learning design team can have its own set of unique challenges. Learning designers have expertise in course design and the technological skills to create best practices in integrating design elements into courses. However, they are not content experts and time must be spent on each topic area to exchange information and insight into both the content, the learning objectives, and the course designers' vision. Being able to work with one learning designer through the whole process can make this a more seamless experience and raise the final quality of the product. Having one single point of contact for the course design also helps integrate cultural competence and understanding of how other cultures learn through each design element. Human trafficking in Africa has aspects that are unique to each area and these differences must be incorporated into the learning experience of the students, from the assignments to the visual elements that represent the student's experiences. It should also be noted that the process of course development requires a lot of paperwork and is a cumbersome process that can be foreign to a faculty member.
Multiple faculty members working to create one course can be a difficult endeavor, especially when differing professions and disciplines are involved. Continuous conversations with each other as well as with the learning designer were critical to create a seamless course and to ease frustrations. Additionally, the university library is an oftenforgotten resource which can be utilized as a key member of the IPE team. Their knowledge of resources is critical to harvest high-quality content across multiple topics. Working collaboratively with the library team is a crucial step to reduce search time and to ensure the relevance of the materials used for the course content and readings. The library personnel's expertise can also be helpful in developing Open Educational Resources, or OERs, for each topic/module. When the course is launched, they can also provide support for additional resources and writing help for student participants.
Finally, cultivating community relationships is an invaluable piece of developing an IPE course. This included working with those who might have experience working within the specific geographic area the course was focused on. Fortunately, there was a Catholic sister alumna at the university who was from Africa and was able to provide her perspective of her country's culture, a localized perspective of human trafficking, and most importantly how the content related to Catholic doctrine. Other groups that are critical are any organizations or agencies who are already working in the area of human trafficking, such as several existing networks of Catholic sisters that were found currently addressing human trafficking in Africa. Throughout this process, it is also important to recognize that the grant funder has its own needs and agenda, which may not be the same as the course developers'. Balancing each of these perspectives helped create a collaborative course that incorporates the perspectives of all stakeholders and addresses the needs of the Catholic sisters who would ultimately take the course.

Leadership
Leadership issues in IPE can be defined as the level of support and organization of university administration (Bridges et al., 2011;Sunguya et al., 2014). One of the barriers to the course development was the level of commitment at the university level. Initially, decisions around the course development were being made by a project manager who resided in a department different from the course developers. This caused a lack of communication and unclear timelines and commitment from university administration. It is critical to ensure that everyone who has a voice in the progress of the project is engaged in the process and invested in the course success. This includes the registrar's office, university technology services, deans, any vice presidents, and the vice president of academic affairs. The project manager did not have a clear understanding of academic processes. As a result, he was not able to fully address many issues critical to both course design and faculty engagement in the process, such as how credit for joint course development and delivery would be assigned, the impact of the IPE course development on tenure and promotion, and even how or if the courses would be accepted as part of existing majors/degrees. The IPE course development process was halted at some points until the course developers directly engaged the upper level administration to ensure commitments and provide direct answers to the questions relating to faculty involvement in the project.

IPE Approach
Working in an interprofessional team requires everyone be committed to this approach (Sunguya et al., 2014). Faculty must work across fields in the course development and engage with a learning design team, and librarians, while at the same time being able to value and incorporate differing contributions and viewpoints. For instance, the integration of theology was a unique challenge because the course was designed specifically to address human trafficking but also had to address the students' Catholic perspective. Engaging theology and Catholic experts to provide insight and feedback across each stage of development was a crucial element.
Embracing an IPE approach not only involves faculty but extends to the interaction of students with their community and each other. As noted previously, students enrolled in the Human Trafficking course came from over eleven professions. Using an interactive discussion was one way to engage participants in hearing the unique perspectives of this issue from the lens of each student's perspective. Another way this was addressed was having the sisters develop an implementation plan within their community by identifying the multitude of resources, agencies, and organizations that would need to collaborate to address this issue in their communities.

Teaching
In the creation and delivery of this IPE course, several challenges related to teaching arose. First, the team needed to manage different policies across academic and nonacademic departments. Expectations of what online courses should look like differed in each of the academic departments and these differences needed to be resolved to develop one consistent course. With respect to non-academic departments, barriers to student enrollment and library access required working with University Technology Services and the library to change or create new systems to accommodate the demands of an IPE course.
Another teaching challenge involved finding ways to engage the Catholic sisters, given that they were taking this course on a continent different from the instructors' and perhaps thousands of miles away from their online classmates. The time-zone difference had to be considered in the design of the assignments and the participants' interactions with each other. One strategy employed was to have the sisters practice role playing with others online or in their local communities. When they competed this activity, they were able to post in an online discussion forum and get constructive feedback from their peers and the instructor.

Resources
The development of an IPE course took more time than initially planned. When developing a course for a single profession, the content and context are often familiar to the course developer. However, when working in an IPE team, it is important to spend time developing relationships among team members, managing differences of opinion about content, course design elements, and accreditation requirements, and even adjusting to differing workstyles across participants and disciplines.

Use of Interprofessional Course
Previous studies as well as our initial findings suggest there are strong benefits for students in taking interprofessional courses. Creating opportunities for students to develop collaborations within their local context is a key element to a successful IPE experience (Green & Johnson, 2015). Our results found that 86% of our students had a plan to begin networking and collaborating with others and 14% had already begun these practices. This was illustrated by one sister who was able to develop an opportunity to link together two existing contacts, the International Office on Migration (IOM) and her local parish priest: I have learnt that networking is more beneficial than fighting this issue alone. Therefore, I have already shared with IOM's coordinator my desires on how I want to sensitize the migrants that come at our parish. I met the parish priest and he agreed to offer us a conference room. After this encounter, IOM gave me a collaborator named Mohamed [pseudonym]. We are already planning to have three events: one for the minors, one for women and another for men. We will start these events in September after my holidays; the date is not yet set.
In addition to specific events and activities, many of the sisters were able to identify how their own professional skills could complement those of others by working collaboratively with different groups and professions. The students talked about organizing meetings with stakeholders such as community members, parents, youth leaders, school personnel, government officials, local organizations, and local businesses. Whether it was with local nongovernmental organizations or advocacy groups, there was a recognition that addressing this problem was not something that could be done alone. Having allies was an important component of their plans moving forward when fighting to solve this issue.
In addition to a range of stakeholders, there was also discussion of the different types of professionals that would be needed to create a comprehensive prevention, intervention, and recovery model. This included addressing economic issues that might put youth at greater risk for being trafficked, listing different groups that could be enlisted to rescue victims, and finally the hosting of professionals that would be needed to help address, physical, emotional, and spiritual trauma that survivors endure. These findings support earlier studies but elaborate further with specifics on how collaborations may occur, where, and with whom.

Limitations
There are limitations to this study which hinder generalizing the findings. For instance, the students were rather homogeneous in that they were all Catholic Sisters working in Africa. These are not the typical students that social work educators teach or for whom they develop courses. However, that was a restriction of the funder. An additional limitation was the use of only qualitative data. This limited the scope of the findings and implications.

Implications for Interprofessional Education
Overall, this project included developing an interprofessional course for Catholic sisters and providing insight into how the students used interprofessional skills after taking the course. While the barriers presented several challenges in the development and implementation of this IPE course, many of these were overcome through collaboration, communication, partnerships, and structural changes. Although not all challenges can be anticipated, the recommendations should help other social work educators as they develop IPE courses moving forward. Having administrative support, committed collaborative relations, and an underlying technological infrastructure are required to implement a successful IPE course (Bridges et al., 2011). How these are addressed may vary by institution but being able to pre-emptively address potential challenges allows the design and development process to be more efficient.
Further research regarding outcomes for academic organizations, faculty, and staff are warranted to support further interprofessional courses. These results could support the changes required to successfully create and deliver these types of courses. Infrastructure in academia must be reconsidered in order to facilitate these endeavors more efficiently. For instance, policies regarding credit, pay, and full-time equivalency (FTE) must be addressed, as well as silos, which interfere with interprofessional course development and delivery. Resources must be provided as well as other experts (i.e., librarian, learning designer) in order to efficiently and effectively produce quality courses.
In addition, there is a dearth of studies assessing the application of interprofessional skills and the students' attitudes. Beginning studies have suggested improvements in collaboration, connection, and respect for other professions; however, far more studies are needed. If academia is to remain relevant, it needs to provide educational experiences which directly influence professional work. Interprofessional courses may provide students an opportunity to think beyond their discipline and enhance critical thinking skills and problem-solving skills. This is what the workforce is demanding.
Finally, the profession of social work is very familiar and comfortable with cooperating, supporting, and collaborating with other professionals outside of academia. For example, we work in hosted contexts such as: schools, medical facilities, corrections etc. and other non-hosted environments where we effectively assist clients while managing professional differences. These capabilities are not typical of other professions and we should use these skills to drive change within academia. Our knowledge, interdisciplinary theoretical perspectives, code of ethics, and dexterity galvanize us as natural leaders in the endeavor of creating and delivering interprofessional courses and programs.