By ensuring basic physiological subsistence within a framework of safety, a sense of security can be created. A person can then work towards those needs which are placed at the higher levels of Maslow’s pyramid.86 in the development of a relationship of trust between client and clinician. It can be seen as a process in which different layers of the “pyramid” are approached simultaneously, rather than simply working upwards from its base. This is reflected in the HBF “hub and spoke” care model (illustration above). Consideration of clients’ physical and psychological health is similarly holistic. For example, a person who requires documentation of physical injuries scarring may also be observed to be suffering distress about the way in which the injury was sustained which has led to psychological trauma symptoms; or they may have become habituated to supporting the injury through adoption of poor posture or a limp. HBF’s “hub and spoke” care model HBF’s own care model is built upon an integrated or “holistic” response to the changing needs of its clients. In terms of clinical delivery and time frame, the needs identified in Maslow’s pyramid are inter-linked for each individual person87 rather than divided into straightforward layers. To explain this further, at HBF a client will be initially assessed, and assisted through discussion to identify their own immediate needs and how they prioritize them. This process establishes the client’s autonomy from the outset as well as helping them to feel that they are part of a “team” with mutually agreed goals and expectations. HBF’s experience has shown that this integrated approach greatly assists Advocacy Social Wellbeing and Integration Education HBF Clients Mind & Body Therapies Protection Work Healthcare Rehabilitation Therapies Maslow’s hierarchy of needs; The Hub 90 The serious practical difficulties that are experienced by HBF’s client group means that their therapeutic care has to extend to working in response to urgent problems as they arise. This can disrupt formal therapeutic service provision, however, prioritizing the practical needs of clients is fundamental to their protection and safety. Consistency of service and a sense of security for clients is provided by ensuring that the client-clinician relationship is at all times appropriate, and that professional boundaries are maintained. In cases where a crisis has arisen and been dealt with, return to a regular framework of therapeutic care is made as soon as possible. HBF’s practices conform to the requirements of the Istanbul Protocol88, which states that, “Wherever possible, examinations to document torture for medical-legal reasons should be combined with an assessment for other needs”.89 This work is challenged not only by the pressure of external decision-making deadlines and stretched resources, but also by the myriad problems that are faced by victims of trafficking at the initial stages of their referral, and those that can arise further on. Manual on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, “Wherever possible, examinations to document torture for medical-legal reasons should be combined with an assessment for other needs, whether referral to specialist physicians, psychologists, physiotherapists or those who can offer social advice and support. Investigators should be aware of local rehabilitation and support services. The clinician should not hesitate to insist on any consultation and examination that he or she considers necessary in a medical evaluation. In the course of documenting medical evidence of torture and ill-treatment, physicians are not absolved of their ethical obligations. Those who appear to be in need of further medical or psychological care should be referred to the appropriate services.”