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Mangual KPS, Patin E, Chandler M, Grant-Kels JM, Lederer LJ, Kourosh AS. Part III - Navigating an Encounter with a Trafficked Person in the Dermatology Clinic. Clin Dermatol 2024:S0738-081X(24)00199-8. [PMID: 39341514 DOI: 10.1016/j.clindermatol.2024.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2024]
Abstract
Patients experiencing or having experienced trafficking frequently interact with the healthcare system, highlighting the need for healthcare providers to be equipped with the appropriate tools to serve these patients effectively. The third part of this series focuses on navigating encounters with trafficked persons within the dermatology clinic, emphasizing the importance of trauma-informed, patient-centered care. We review the barriers trafficked patients face and mechanisms to overcome these, the importance of comprehensive needs assessments, and the implementation of effective healthcare protocols. Additionally, we review the role of dermatologists in mandatory reporting and the use of appropriate ICD-10 codes for documenting a potential trafficking victim encounter in the electronic medical record. We conclude with recommendations for specialized training, emphasizing the critical role dermatologists play in identifying and supporting trafficked patients within the healthcare system.
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Affiliation(s)
- Kathyana P Santiago Mangual
- Department of Dermatology, Massachusetts General Hospital, Boston, MA; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Eryn Patin
- Department of Dermatology, Massachusetts General Hospital, Boston, MA; University of Texas Southwestern Medical School, Dallas, TX
| | | | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT; Department of Dermatology, University of Florida College of Medicine, Gainesville, FL
| | | | - Arianne Shadi Kourosh
- Department of Dermatology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
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2
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Grosgogeat CA, Medwid K, Mahmoud RH, Hensley B. Identification of a Human Trafficking Victim: A Simulation. JOURNAL OF EDUCATION & TEACHING IN EMERGENCY MEDICINE 2024; 9:S1-S29. [PMID: 39129728 PMCID: PMC11312875 DOI: 10.21980/j8293f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 06/21/2024] [Indexed: 08/13/2024]
Abstract
Audience This case was designed for emergency medicine interns and residents. Introduction Human trafficking is unfortunately an ever-growing and wide-reaching problem in the United States as well as the rest of the world. The International Labor Organization estimates 49.6 million people were affected by this modern-day slavery worldwide in 2021.1,2 The emergency department represents an opportunity to identify and provide aid to victims of human trafficking. Studies have shown that 63.3% of survivors interacted with the emergency department during their time of exploitation; however, most of these patients are not identified as human trafficking victims and opportunities for intervention are missed.3,4. Educational Objectives By the end of this simulation, participants will be able to: (1) Identify signs of human trafficking. (2) Demonstrate the ability to perform a primary and secondary assessment of a patient when there is concern for human trafficking. (3) Demonstrate the ability to appropriately separate an at-risk patient from a potential trafficker. (4) Identify resources and a reliable course of action to permanently remove the patient from the harmful situation. Educational Methods A hybrid teaching model was employed that included both a lecture and a standardized patient simulation session followed by a structured debriefing session. Research Methods A simulation with a standardized participant was implemented at an urban academic emergency department with a three-year EM residency program. Participants were evaluated with a survey prior to and after the simulation, where they responded to questions regarding human trafficking patients on a scale of 1 to 5, where 5 represented the greatest level of agreement. Nineteen emergency medicine interns and residents participated in this project. Results Prior to simulation training, and after the lecture, residents were surveyed on their confidence in identifying and treating patients who are affected by trafficking, their level of previous training in this topic, and whether they considered trafficking an important issue in emergency medicine. When asked if human trafficking is an important issue faced by the emergency department, 15 of the 19 of residents who completed the survey rated the importance a 5/5 on a Likert scale ranging from 1-not important to 5. Residents were also asked if they had received prior training in human trafficking on a scale of never (1) to often (5). Eight residents responded with either never or close to never. Two months after the simulation, the residents were again sent an optional survey. Ten residents responded. All who participated in the simulation now rated themselves a 4/5 on a scale from not confident to very confident. Of those who did not attend the simulation, the median value was a 3/5. Out of the residents who attended the simulation training, every resident rated the experience 5 out of 5 in terms of usefulness. One hundred percent of residents would recommend simulation training on human trafficking to other emergency medicine residents. Discussion This was an effective educational initiative because this education model allowed the residents to feel more comfortable identifying individuals affected by human trafficking, and all the residents who responded to the survey stated that they would recommend the use of simulation to others for education on human trafficking. Topics High-fidelity simulation, human trafficking identification, human trafficking response.
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Affiliation(s)
| | - Kelly Medwid
- Jackson Memorial Hospital/University of Miami, Department of Emergency Medicine, Miami, FL
| | - Rami H Mahmoud
- University of Miami, Miller School of Medicine, Miami, FL
| | - Brooke Hensley
- Jackson Memorial Hospital/University of Miami, Department of Emergency Medicine, Miami, FL
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Braun B. Human Trafficking Awareness in the Emergency Care Setting: Joint Position Statement. JOURNAL OF FORENSIC NURSING 2024; 20:E53-E56. [PMID: 39102314 DOI: 10.1097/jfn.0000000000000504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Affiliation(s)
- Brenda Braun
- Author Affiliation: Emergency Nurses Association
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Meshelemiah JCA, Dellor E, Karandikar S, Munshi A, Barboza-Salerno G, Steinke HR. Adverse Childhood Experiences, Women Who Are Sex Trafficked, and Social Service Utilization: Implications for Social Work. SOCIAL WORK 2024; 69:265-275. [PMID: 38745387 DOI: 10.1093/sw/swae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 02/09/2024] [Accepted: 03/17/2024] [Indexed: 05/16/2024]
Abstract
The aim of this study was to examine the associations between adverse childhood experiences (ACEs) and the high levels of social service usage by women who are sex trafficked. Fifty (N = 50) women who were sex trafficked were surveyed using purposive and snowball sampling methods. The ACEs score for respondents ranged from 2 to 10 with an average score of 7.4 (SD = 2.3). Emotional and sexual abuse tied at 88 percent as the most frequently cited ACEs among the women in this sample. The prevalence of ACEs was significantly higher in this sample compared with known estimates in similar populations, ranging from 20 percent to 54 percent (p < .001). Considering the well-established link between ACEs and poor health outcomes, these findings point to the need for innovative and targeted social service provisions to women who were formerly sex trafficked that take into consideration the high level of ACEs of the women. Given the sociodemographic diversity of this sample, there is a need for services that are trauma-informed, innovative, and culturally sensitive in a variety of social service settings.
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Affiliation(s)
- Jacquelyn C A Meshelemiah
- Jacquelyn C. A. Meshelemiah, PhD, is associate professor, College of Social Work, The Ohio State University, 325D Stillman Hall, 1947 North College Road, Columbus, OH 43210, USA
| | - Elinam Dellor
- Elinam Dellor, PhD, is an assistant professor, College of Social Work, The Ohio State University, Columbus, OH, USA
| | - Sharvari Karandikar
- Sharvari Karandikar, PhD, is a professor, College of Social Work, The Ohio State University, Columbus, OH, USA
| | - Additti Munshi
- Additti Munshi, MSW, is a doctoral student, College of Social Work, The Ohio State University, Columbus, OH, USA
| | - Gia Barboza-Salerno
- Gia Barboza-Salerno, JD, PhD, is an assistant professor, College of Social Work, The Ohio State University, Columbus, OH, USA
| | - Hannah Ruth Steinke
- Hannah Ruth Steinke, BA, is a graduate research associate, College of Social Work, The Ohio State University, Columbus, OH, USA
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Molyneux K, Singer E. Asylum seekers and the role of the acute care physician. J Am Coll Emerg Physicians Open 2024; 5:e13196. [PMID: 38887226 PMCID: PMC11180694 DOI: 10.1002/emp2.13196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 04/23/2024] [Accepted: 05/02/2024] [Indexed: 06/20/2024] Open
Abstract
There has been a recent influx of migrants and asylum seekers to the United States. They often arrive with poor social support and an inability to access reliable health care. This can lead to overutilization of emergency departments (ED) while awaiting legal proceedings. With asylum seekers in all 50 states, it is important for emergency physicians (EP) to understand the barriers to care and difficulties asylum seekers face, and to gain tools to improve both migrants' and community health. Migration and experiences within the United States can worsen pre-existing health conditions. EPs are uniquely positioned to screen for acute pathology and link people to care. Psychiatric illnesses may present differently in asylum seekers. EPs must understand the sequalae of trauma to address it. EPs must also be aware of legal protections for asylum seekers to care for these patients, and recognize challenges faced by the population to mitigate health disparities.
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Affiliation(s)
- Kevin Molyneux
- Department of Emergency MedicineColumbia UniversityNew YorkNew YorkUSA
| | - Elizabeth Singer
- Departments of Emergency Medicine and Medical EducationIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
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Roe-Sepowitz D, Bracy K, Gibbs H, Stafford RL, Bernardin B, Stoklosa H. PEARR tool training and implementation: building awareness of violence and human trafficking in a hospital system. Front Med (Lausanne) 2024; 11:1311584. [PMID: 38784222 PMCID: PMC11112017 DOI: 10.3389/fmed.2024.1311584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 04/29/2024] [Indexed: 05/25/2024] Open
Abstract
Introduction Health professionals have an opportunity to assist patients who are experiencing many types of violence, including human trafficking; however, current approaches are often not person-centered. The Provide privacy, Educate, Ask, Respect and Respond (PEARR) Tool, a recognized screening tool in the U.S., is a structured conversation guide for health professionals on how to provide trauma-sensitive assistance to patients who may be experiencing such violence, including human trafficking. This is the first study to evaluate the PEARR Tool and its use in hospital settings. Methods A U.S.-based health system adopted the PEARR Tool as part of its Abuse, Neglect, and Violence policy and procedure. To support successful adoption, the health system also developed educational modules on human trafficking and trauma-informed approaches to patient care, including a module on the PEARR steps. In October 2020 and June 2021, a voluntary "PEARR Tool Training and Implementation Survey" was distributed to emergency department staff in three hospitals. The survey consisted of 22 questions: eight demographic and occupation related questions; five questions related to the education provided to staff; and, nine questions related to the use of the PEARR Tool in identifying and assisting patients. Results The overall findings demonstrate a general increase in awareness about the prevalence of human trafficking, as well as a significant increase in awareness about the implementation of the PEARR Tool. However, the findings demonstrate that most respondents were not utilizing the PEARR Tool between October 2020 and June 2021. Most reported that the reason for this was because they had not suspected any of their patients to be victims of abuse, neglect, or violence, including human trafficking. Of those that had utilized the PEARR Tool, there was a marked increase in staff that reported its usefulness and ease of access when caring for patients. Discussion The COVID-19 pandemic posed many challenges during this study, including delays in staff education, changes in education format and delivery, and strains on staff. Initial data regarding the use of the PEARR Tool is promising; and additional research is recommended.
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Affiliation(s)
| | - Kristen Bracy
- School of Social Work, Arizona State University, Phoenix, AZ, United States
| | - Holly Gibbs
- CommonSpirit Health, Chicago, IL, United States
| | | | - Brooke Bernardin
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Hanni Stoklosa
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
- HEAL Trafficking, Long Beach, CA, United States
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Mirza MU, Jiang C, Forde JJ, Barkin JA, Sussman DA, Manten EM. See Something, Say Something: Global Positioning System Tracker Foreign Body Ingestion as a Unique Presentation of Human Trafficking. ACG Case Rep J 2024; 11:e01301. [PMID: 38501036 PMCID: PMC10948129 DOI: 10.14309/crj.0000000000001301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 01/31/2024] [Indexed: 03/20/2024] Open
Abstract
In 2021, there were about 17,000 victims of human trafficking in the United States. We present a case of a 28-year-old sex trafficking victim who was forced to swallow 2 global positioning system trackers by her perpetrator. The gastroenterology team performed an upper endoscopy and retrieved 2 global positioning system devices from her antrum. Most of these victims do not disclose any history of abuse because of fear of their perpetrators. Further training and research can help to allow for recognition of these victims and potentially help them.
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8
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Meredith AC. Identifying victims of labor trafficking. JAAPA 2024; 37:29-32. [PMID: 38128136 DOI: 10.1097/01.jaa.0000995652.37567.c2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
ABSTRACT Globally, more than 40 million people are victims of human trafficking, exploited as a black-market commodity generating more than $150 billion annually. These people are forced to work in various industries, including domestic work and escort services. Though studies are limited, survivor interviews have indicated that most trafficked persons presented to a healthcare provider at some point during their captivity. No single validated tool exists for screening all victims of human trafficking across all healthcare settings, but several mechanisms are available for immediate implementation, and all have the potential to pierce the veil and spare a life from further abuse.
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Affiliation(s)
- Angela C Meredith
- Angela C. Meredith practices at Moore Free and Charitable Clinic in Southern Pines, N.C. The author has disclosed no potential conflicts of interest, financial or otherwise
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9
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Duke DO, Allard D, Dysart S, Hogan KO, Phelan S, Rawlings L, Stoklosa H. Automated informatics may increase the detection rate of suspicious cases of human trafficking-a preliminary study. JAMIA Open 2023; 6:ooad097. [PMID: 38106607 PMCID: PMC10722470 DOI: 10.1093/jamiaopen/ooad097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 08/14/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023] Open
Abstract
Objectives Worldwide, there is an estimated 40.3 million victims trapped in modern day slavery, including 24.9 million in forced labor and 15.4 million in forced marriage. A majority of labor and sex trafficking survivors report at least one healthcare encounter during their victimization. An approach to an informatics technology solution for identifying trafficked persons in real time, in the hospital / emergency department settings is the primary focus of this paper. Materials and methods Octavia, a software application implemented in 3 California hospitals, scanned all patient encounters for social and clinical determinants that are consistent predictors of HT. Any encounter that matched these criteria was forwarded to a specially trained High-Risk Navigator who screened the data and when able, made direct contact in an effort to build rapport and possibly provide victim assistance. Results During the observation period, the automated scanning of hospital patient encounters resulted in a notable increase in the detection of persons who had a likelihood of being trafficked when compared to a pre-project baseline. Discussion Our experience demonstrated that automated technology is useful to assist healthcare providers in identification of potentially trafficked persons, improving the likelihood of care provision.
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Affiliation(s)
| | - Derin Allard
- Family Medicine Residency Program, Marian Medical Center, Santa Maria, CA, United States
| | - Suzanne Dysart
- Obstetrics and Gynecology, Marian Medical Center, Santa Maria, CA, United States
| | - Keenan O Hogan
- Pathology and Laboratory Medicine, University of Kansas Health System, Kansas City, KS, United States
| | - Suzanne Phelan
- Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, CA, United States
| | - Luke Rawlings
- Family Medicine Center, Pacific Central Coast Health Centers, Santa Maria, CA, United States
| | - Hanni Stoklosa
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
- HEAL Trafficking, Long Beach, CA, United States
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10
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Valdes B, Salani D, Falcon A, McKay M, Arrojo M, Quintana A, DeSantis JP. A simulated pedagogical intervention to educate nurse practitioner students about human trafficking. J Am Assoc Nurse Pract 2023; 35:717-724. [PMID: 37610785 DOI: 10.1097/jxx.0000000000000913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/25/2023] [Indexed: 08/24/2023]
Abstract
ABSTRACT Human trafficking (HT) affects an estimated 40.3 million people globally with 24.9 million people affected in forced labor and 4.8 million in forced sexual exploitation. An estimated 18,000 people are trafficked yearly into the United States. Reports suggest that between 63% and 87% of trafficked persons were seen by health care professionals and were unrecognized while in captivity. The authors designed and implemented an innovative pedagogical intervention for nurse practitioner (NP) students using a 10-min simulation-based education encounter with a standardized patient depicting a potential sex or labor HT clinical presentation. Results demonstrated that simulation-based education is a feasible way to provide HT education to NP students. It is imperative that future NPs receive education/training about HT to recognize potential victims and promote access to appropriate resources.
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Affiliation(s)
- Beatriz Valdes
- University of Miami School of Nursing and Health Studies, Coral Gables, Florida
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11
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Cohen PR. Identifying Human Trafficking Victims: A Potential Role for Forensic Dermatology. Cureus 2023; 15:e48905. [PMID: 38106780 PMCID: PMC10725279 DOI: 10.7759/cureus.48905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 12/19/2023] Open
Abstract
Human trafficking is a worldwide problem that predominantly affects women and children. The victims are recruited by coercion, deception, or force and then exploited for commercial sex acts or labor, or both. Human trafficking results in severe suffering of the victims including not only physical injuries but also psychological consequences. Many of the victims of human trafficking encounter the medical system; however, this chance for potential intervention is often not realized by the clinician treating the individual. Many of the manifestations of injuries to human trafficking victims involve the skin, hair, nails, and mucosa. Hence, there is a paramount opportunity for forensic dermatology in the detection and evaluation of suspected victims of human trafficking. Cutaneous manifestations frequently observed in victims of sex trafficking include branding (with tattoos), rashes, bruising, and sequelae of self-injurious behavior; in addition, mucocutaneous stigmata of sexually transmitted diseases may be present. Skin features more commonly associated with victims of labor trafficking include deep and long cuts, skin injuries (such as bruises and tears), and scars from prior burns and knife cuts. The presence of an uncommon infection affecting the skin, such as new world leishmaniasis, that only occurs in a specific and restricted geographic endemic area can also be a subtle clue to human trafficking. Forensic dermatology has the potential to identify victims of human trafficking; when a healthcare worker entertains the possibility of human trafficking, a comprehensive cutaneous examination may provide objective evidence that the individual who is being evaluated and treated may be a human trafficking victim and therefore prompt the clinician to initiate appropriate intervention.
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Affiliation(s)
- Philip R Cohen
- Dermatology, University of California, Davis Medical Center, Sacramento, USA
- Dermatology, Touro University California College of Osteopathic Medicine, Vallejo, USA
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Preble KM, Twis M, Kollmeyer S, Greenwood D. Defiance and Strength: A Qualitative Study of Sex Trafficking Survivor-Advocate Coping Strategies. VIOLENCE AND VICTIMS 2023; 38:717-735. [PMID: 37813574 DOI: 10.1891/vv-2022-0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
In the two decades since federal law prohibited the trafficking of humans for sexual or nonsexual services, researchers have generated knowledge related to the mental and physical health consequences of the experience, the individual and environmental factors that facilitate exploitation, and the best practices for prevention and intervention. Despite these advances in knowledge about human trafficking, relatively scant research has explored the resiliencies of survivors, as a deficit-based narrative persists when exploring and contemplating survivor experiences. While the movement increasingly recognizes the need to situate the survivor voice in service delivery, advocacy, and research, an inquiry that values survivor strengths remains nascent. Using the Intersectional-Standpoint Methodology (ISM) and phenomenology, this qualitative study explores the nuances of resiliency during exploitation and exit among seven sex trafficking survivor-advocates in a small midwestern state. Themes related to coping strategies, intrapersonal coping skills, and interpersonal coping skills were revealed and contextualized through the four variables proposed in ISM. Implications for service provision and policy are provided.
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Affiliation(s)
| | - Mary Twis
- Department of Social Work, Texas Christian University, Fort Worth, TX, USA
| | | | - Don Greenwood
- Social Work, Texas Christian University, Fort Worth, TX, USA
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Gutfraind A, Yagci Sokat K, Muscioni G, Alahmadi S, Hudlow J, Hershow R, Norgeot B. Victims of human trafficking and exploitation in the healthcare system: a retrospective study using a large multi-state dataset and ICD-10 codes. Front Public Health 2023; 11:1243413. [PMID: 37841726 PMCID: PMC10568010 DOI: 10.3389/fpubh.2023.1243413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/30/2023] [Indexed: 10/17/2023] Open
Abstract
Trafficking and exploitation for sex or labor affects millions of persons worldwide. To improve healthcare for these patients, in late 2018 new ICD-10 medical diagnosis codes were implemented in the US. These 13 codes include diagnosis of adult and child sexual exploitation, adult and child labor exploitation, and history of exploitation. Here we report on a database search of a large US health insurer that contained approximately 47.1 million patients and 0.9 million provider organizations, not limited to large medical systems. We reported on any diagnosis with the new codes between 2018-09-01 and 2022-09-01. The dataset was found to contain 5,262 instances of the ICD-10 codes. Regression analysis of the codes found a 5.8% increase in the uptake of these codes per year, representing a decline relative to 6.7% annual increase in the data. The codes were used by 1,810 different providers (0.19% of total) for 2,793 patients. Of the patients, 1,248 were recently trafficked, while the remainder had a personal history of exploitation. Of the recent cases, 86% experienced sexual exploitation, 14% labor exploitation and 0.8% both types. These patients were predominantly female (83%) with a median age of 20 (interquartile range: 15-35). The patients were characterized by persistently high prevalence of mental health conditions (including anxiety: 21%, post-traumatic stress disorder: 20%, major depression: 18%), sexually-transmitted infections, and high utilization of the emergency department (ED). The patients' first report of trafficking occurred most often outside of a hospital or emergency setting (55%), primarily during office and psychiatric visits.
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Affiliation(s)
- Alexander Gutfraind
- Carelon Inc., Indianapolis, IN, United States
- Department of Medicine, Loyola University Chicago School of Medicine, Maywood, IL, United States
- Division of Epidemiology and Biostatistics, University of Illinois School of Public Health, Chicago, IL, United States
| | - Kezban Yagci Sokat
- Marketing and Business Analytics, San Jose State University, San Jose, CA, United States
| | | | - Sami Alahmadi
- Georgetown University, Washington, DC, United States
| | | | - Ronald Hershow
- Division of Epidemiology and Biostatistics, University of Illinois School of Public Health, Chicago, IL, United States
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14
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Shekhar AC, Macias-Konstantopoulos WL. Human Trafficking and Emergency Medical Services (EMS). Prehosp Disaster Med 2023; 38:541-543. [PMID: 37403463 DOI: 10.1017/s1049023x23005976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
Human trafficking is associated with wide-ranging mental and physical morbidity, as well as mortality, in the United States and globally. Emergency Medical Services (EMS) providers are often first responders to victims of human trafficking. Given their proximity to patients' social and environmental circumstances, these clinicians need to be familiar with the signs and symptoms of human trafficking, as well understand how to best provide care for suspected or confirmed trafficked patients. Evidence from multiple studies indicates that providers who have received formal training may be better able to recognize the signs and symptoms of human trafficking, and thus, can provide better care to potential victims of human trafficking. This review will summarize the relevance of human trafficking to prehospital emergency care, touch on best practices for the care of patients with suspected or confirmed ties to human trafficking, and outline future directions for education and research.
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Affiliation(s)
- Aditya C Shekhar
- Icahn School of Medicine at Mount Sinai, New York City, New YorkUSA
- Harvard Medical School, Boston, MassachusettsUSA
| | - Wendy L Macias-Konstantopoulos
- Harvard Medical School, Boston, MassachusettsUSA
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MassachusettsUSA
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15
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Ferro HP, Williams K, Holbrook DS, O'Conor KJ. Disproportionate impact of abortion restriction: Implications for emergency department clinicians. Am J Emerg Med 2023; 69:160-166. [PMID: 37121065 DOI: 10.1016/j.ajem.2023.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/11/2023] [Accepted: 04/18/2023] [Indexed: 05/02/2023] Open
Abstract
Individuals experiencing intimate partner violence (IPV) and/or human trafficking (HT) are at increased risk of severe health consequences as a result of legislation criminalizing and/or restricting abortion, which is expected to increase as a result of the Supreme Court decision Dobbs v. Jackson. These risks are further stratified by race, socioeconomics, and other marginalizing demographic attributes. IPV and HT introduce barriers to maintaining physical and mental health, due to control of access to transportation and funds by the abuser, fear of retribution for seeking healthcare, and other barriers. Individuals experiencing IPV or HT often lack reproductive autonomy, as a result of facing reproductive coercion at the hands of their abusers. Following the Dobbs decision, these vulnerable patient populations will face further limitations on their reproductive autonomy and increased obstacles to obtaining an abortion if they medically need or desire one. This will likely result in more patients presenting to the emergency department due to complications from unsafe or unsupervised self-managed abortions, as well as patients being reluctant to report having obtained an unlawful abortion due to fear of legal consequences. This is particularly relevant to individuals experiencing IPV and HT, as they may be more likely to use these methods for obtaining an abortion due to numerous barriers. Emergency medicine clinicians are vital in providing care to these patients, as they frequently present to emergency departments. A multi-pronged approach to better support these patients is essential, involving an increased index of suspicion for IPV, HT or the complications of unsupervised abortion, improved organizational structures, specialized training for staff, improved screening methods, reflection on implicit bias, and recommendations for mindful documentation and legal considerations.
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Affiliation(s)
- Haleigh P Ferro
- Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21287, United States.
| | - Kelly Williams
- Johns Hopkins Medicine, 1800 Orleans St, Baltimore, MD 21287, United States.
| | - Debra S Holbrook
- Mercy Medical Center, 345 St. Paul Pl, Baltimore, MD 21202, United States.
| | - Katie J O'Conor
- Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21287, United States.
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Dell N, Koegler E, Holzer KJ, Vaughn MG, Bitter C, Price RK. ICD-10-CM codes infrequently used to document human trafficking in 2019 Nationwide Emergency Department Sample. Am J Emerg Med 2023; 64:37-42. [PMID: 36435008 DOI: 10.1016/j.ajem.2022.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/04/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION People who experience human trafficking (HT) visit emergency departments (ED). The International Classification of Diseases, Clinical Modification (ICD-10-CM) introduced codes to document HT in June 2018. The aim of this study is to identify characteristics of ED patients who experienced forced labor or sexual exploitation as a documented external cause of morbidity in US visits. METHODS Nationally representative surveillance based on patient visits to 989 hospital-owned EDs in the Nationwide Emergency Department Sample in 2019 became available in 2021. Eight ICD-10-CM codes to classify HT as an external cause of morbidity were combined into one HT variable for analysis in 2021-2022. RESULTS A weighted count of 517 of 33.1 million ED visits (0.0016%) documented HT as an external cause of morbidity. Of them, sexual exploitation (71.6%) was documented more frequently than labor exploitation (28.4%). Most HT-related codes were visits by females (87.3%) from large metropolitan areas, and identified as white. Approximately 40% of visits were from ZIP codes with a median household income less than $48,000 annually. Relative to all other ED visits, patients with HT as an external cause of morbidity had higher odds of being female (OR = 6.54, 95% CI:3.59, 11.92) and being a minor (OR = 1.76, 95% CI:1.02, 3.04). CONCLUSION HT was rarely documented as an external cause of morbidity in 989 hospitals' ED visits from a nationally representative sample in 2019. Documentation of recently added HT ICD-10-CM codes does not appear to have been implemented sufficiently to yield an unbiased representation of those who experienced HT and presented in the ED. Efforts to enhance the utility of ICD-10-CM HT codes for surveillance and documentation must first address ED personnel training on identification and response to HT. In doing so, ED personnel also need to address ethical concerns (e.g. stigma, confidentiality, risk of patient harm) and allow for informed consent among trafficked patients in order to be scaled up responsibly.
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Affiliation(s)
- Nathaniel Dell
- Saint Louis University, School of Social Work, 3550 Lindell Blvd., St. Louis, MO 63103, United States of America.
| | - Erica Koegler
- University of Missouri-St. Louis, School of Social Work, 1 University Blvd., St. Louis, MO 63121, United States of America.
| | - Katherine J Holzer
- Washington University in St. Louis, School of Medicine, 660 Euclid Ave., St. Louis, MO 63110, United States of America.
| | - Michael G Vaughn
- Saint Louis University, School of Social Work, 3550 Lindell Blvd., St. Louis, MO 63103, United States of America.
| | - Cindy Bitter
- Saint Louis University, School of Medicine, 3691 Rutger St., St. Louis, MO, United States of America.
| | - Rumi Kato Price
- Washington University in St. Louis, School of Medicine, 660 Euclid Ave., St. Louis, MO 63110, United States of America.
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17
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Sex Trafficking: A Literature Review With Implications for Health Care Providers. Adv Emerg Nurs J 2022; 44:248-261. [PMID: 35900246 DOI: 10.1097/tme.0000000000000419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sex trafficking often goes unrecognized, yet is a pervasive issue that disproportionately affects marginalized populations. Survivors suffer adverse health effects and often present to health care facilities while still under control of their traffickers. Health care providers, including nurses and advanced practice nurses, lack understanding of risk factors, signs and symptoms, and means of offering assistance. A comprehensive literature search was conducted utilizing EBSCOhost and WorldCat. Studies were considered eligible for inclusion if subject matter dealt directly with domestic sex trafficking and included implications for health care or health care education. There are some identified risk factors that place people at higher risk for victimization and survivors may present for care with a common symptom, including physical and mental health issues. Barriers to care include both survivor and health care system characteristics; however, health care providers can undertake specific actions to help overcome these barriers. Health care providers are in a prime position to identify and assist sex trafficking survivors. However, they need to be aware of common risk factor presentations, and they need to be trained to offer assistance. Ongoing research is needed to determine the best way to develop, introduce, and evaluate these trainings.
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18
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Cheetham AL, Hurst IA. Human Trafficking: When to Suspect in the Pediatric Emergency Department? Pediatr Emerg Care 2022; 38:167-171. [PMID: 35358145 DOI: 10.1097/pec.0000000000002685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Human trafficking, which includes sexual exploitation and forced labor, affects youth throughout the world. Victims are subject to coercion, exploitation, and repeated trauma. Given the secretive nature of this abuse, it can be difficult to identify victims. Past experience shows that most victims interact with the healthcare system at some time while they are in the control of a trafficker, providing an opportunity for healthcare providers to identify, support, and intervene. In this CME review article, we describe human trafficking, its estimated prevalence, and the identification, evaluation, and management of patients who are victims of human trafficking. Finally, we provide additional resources for practitioners and patients.
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Affiliation(s)
- Alexandra L Cheetham
- From the Pediatric Emergency Medicine Fellow, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Irene A Hurst
- Assistant Professor of Pediatric Emergency Medicine, Division of Pediatric Emergency Medicine, BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI
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19
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Child trafficking and exploitation: Historical roots, preventive policies, and the Pediatrician's role. Curr Probl Pediatr Adolesc Health Care 2022; 52:101167. [PMID: 35367130 DOI: 10.1016/j.cppeds.2022.101167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Pediatricians are uniquely and well positioned to recognize risk factors for and experiences of labor and sex trafficking in children. While clinical and social interventions are well discussed in the literature, the underlying mechanisms that cause and contribute to trafficking are poorly addressed among healthcare professionals. A "colorblind" or otherwise "apolitical" approach to trafficking prevention is ineffective and may be detrimental to the patient-practitioner relationship. Pediatricians must be historico-socially aware of the contexts in which they practice to improve the health of pediatric populations. This article addresses the relevant trafficking legal terminology that may be unfamiliar to most pediatricians and focuses on a few "ism"-schisms (capitalism, racism, sexism, cis-heteronormativity, nativism, and classism) that create vulnerability to trafficking in pediatric populations. The article closes with some intervention recommendations and many more prevention-measure recommendations.
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20
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Marcinkowski B, Caggiula A, Tran BN, Tran QK, Pourmand A. Sex trafficking screening and intervention in the emergency department: A scoping review. J Am Coll Emerg Physicians Open 2022; 3:e12638. [PMID: 35072162 PMCID: PMC8760950 DOI: 10.1002/emp2.12638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 12/08/2021] [Accepted: 12/14/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Human sex trafficking is a global public health crisis. Emergency departments (EDs) are important access points for trafficked persons who seek medical care. However, because of victims' hesitancy to disclose their situation and health care practitioners' lack of training and institutional protocols, many trafficked persons go unrecognized. METHODS We performed a scoping review of current literature. PubMed, SCOPUS, and reference lists were searched to identify articles for inclusion. We aimed to identify gaps in knowledge and shortcomings to assist this vulnerable population. Two reviewers independently screened literature search results and abstracted data from included studies. Descriptive analysis was conducted. RESULTS We selected and analyzed 23 studies that focused on adult human sex trafficking identification, screening, interventions, or education in the ED. Eight (35%) of the publications used a survey model to quantitatively assess outcomes. Many of the other publications were descriptive or qualitative in nature, with some using a structured interview approach. We have observed that no validated or consistent screening tool exists for the identification of possible adult trafficked patients in the ED. However, we found that educational interventions and screening tools can improve health care practitioners' confidence, victim identification, and knowledge of "next steps" for victims. CONCLUSIONS We found that most ED clinicians and staff have little or no formal training in sex trafficking victim identification, support, institutional protocols, or available local resources. Our review demonstrates a paucity of formal training programs, validated adult screening tools, and standardized institutional protocols to aid in the care of trafficked patients in the ED.
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Affiliation(s)
- Bridget Marcinkowski
- Department of Emergency MedicineThe George Washington University School of Medicine and Health SciencesWashingtonDistrict of ColumbiaUSA
| | - Amy Caggiula
- Department of Emergency MedicineThe George Washington University School of Medicine and Health SciencesWashingtonDistrict of ColumbiaUSA
| | - Brandon N. Tran
- Department of Emergency MedicineThe George Washington University School of Medicine and Health SciencesWashingtonDistrict of ColumbiaUSA
| | - Quincy K Tran
- Department of Emergency MedicineUniversity of Maryland School of MedicineBaltimoreMarylandUSA
- Program in Trauma, The R Adams Cowley Shock Trauma CenterUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Ali Pourmand
- Department of Emergency MedicineThe George Washington University School of Medicine and Health SciencesWashingtonDistrict of ColumbiaUSA
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21
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Rambhatla R, Jamgochian M, Ricco C, Shah R, Ghani H, Silence C, Rao B, Kourosh AS. Identification of skin signs in human-trafficking survivors. Int J Womens Dermatol 2022; 7:677-682. [PMID: 35028364 PMCID: PMC8714580 DOI: 10.1016/j.ijwd.2021.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 11/03/2022] Open
Abstract
Human-trafficking survivors suffer significant physical, mental, and social health consequences, prompting them to seek health care services. Although there is research regarding identification protocols for human-trafficking victims, there is no framework outlining the dermatologic patterns of survivors of human trafficking. We sought to identify the dermatologic signs reported in human-trafficking victims to create a framework for dermatologists and the broader medical community to appropriately screen patients at risk. After screening 577 pertinent records in the PubMed and Google Scholar databases for information about the physical signs of human trafficking in health care, 10 final studies were selected. Significant findings of rashes and brandings, such as tattoos, were more likely in sex-trafficked patients, whereas burns, injuries, and deep cuts were more likely to be found in labor-trafficked patients. This review outlines important identification guidelines that dermatologists and the broader medical community can use to recognize victims and take appropriate action while also raising awareness of human trafficking as an emerging public health issue.
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Affiliation(s)
- Raaga Rambhatla
- Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | | | - Cristina Ricco
- Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Rohan Shah
- Rutgers, New Jersey Medical School, Newark, New Jersey
| | - Hira Ghani
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
| | - Channi Silence
- Massachusetts General Hospital Department of Dermatology, Boston, Massachusetts
| | - Babar Rao
- RWJMS, Center for Dermatology, Somerset, New Jersey
| | - Arianne Shadi Kourosh
- Massachusetts General Hospital Department of Dermatology, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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22
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Chisolm‐Straker M, Singer E, Strong D, Loo GT, Rothman EF, Clesca C, d'Etienne J, Alanis N, Richardson LD. Validation of a screening tool for labor and sex trafficking among emergency department patients. J Am Coll Emerg Physicians Open 2021; 2:e12558. [PMID: 34667976 PMCID: PMC8510141 DOI: 10.1002/emp2.12558] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/28/2021] [Accepted: 08/31/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Patients with labor and sex trafficking experiences seek healthcare while and after being trafficked. Their trafficking experiences are often unrecognized by clinicians who lack a validated tool to systematically screen for trafficking. We aimed to derive and validate a brief, comprehensive trafficking screening tool for use in healthcare settings. METHODS Patients were randomly selected to participate in this prospective study based on time of arrival. Data collectors administered 5 dichotomous index questions and a reference standard trafficking assessment tool that requires 30 to 60 minutes to administer. Data collection was from June 2016 to January 2021. Data from patients in 5 New York City (NYC) emergency departments (EDs) were used for tool psychometric derivation, and data from patients in a Fort Worth ED were used for external validation. Clinically stable ED adults (aged ≥18 years) were eligible to participate. Candidate questions were selected from the Trafficking Victim Identification Tool (TVIT). The study outcome measurement was a determination of a participant having a lifetime experience of labor and/or sex trafficking based on the interpretation of the reference standard interview, the TVIT. RESULTS Overall, 4127 ED patients were enrolled. In the derivation group, the reference standard identified 36 (1.1%) as positive for a labor and/or sex trafficking experience. In the validation group, 12 (1.4%) were positive by the reference standard. Rapid Appraisal for Trafficking (RAFT) is a new 4-item trafficking screening tool: in the derivation group, RAFT was 89% sensitive (95% confidence interval [CI], 79%-99%) and 74% specific (95% CI, 73%-76%) and in the external validation group, RAFT was 100% sensitive (95% CI, 100%-100%) and 61% specific (95% CI, 56%-65%). CONCLUSIONS The rapid, 4-item RAFT screening tool demonstrated good sensitivity compared with the existing, resource-intensive reference standard tool. RAFT may enhance the detection of human trafficking in EDs. Additional multicenter studies and research on RAFT's implementation are needed.
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Affiliation(s)
- Makini Chisolm‐Straker
- Department of Emergency MedicineInstitute for Health Equity ResearchIcahn School of Medicine at Mount SinaiMount Sinai QueensNew YorkNew YorkUSA
| | - Elizabeth Singer
- Department of Emergency MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Department of Medical EducationIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - David Strong
- Herbert Wertheim School of Public HealthUniversity of California San DiegoSan DiegoCaliforniaUSA
| | - George T. Loo
- Department of Emergency MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Emily F. Rothman
- Community Health SciencesSchool of Public HealthBoston UniversityBostonMassachusettsUSA
| | - Cindy Clesca
- Department of Emergency MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - James d'Etienne
- Department of Emergency Medicine, Integrative Emergency ServicesJohn Peter Smith HospitalFort WorthTexasUSA
| | - Naomi Alanis
- Department of Emergency Medicine, Integrative Emergency ServicesJohn Peter Smith HospitalFort WorthTexasUSA
| | - Lynne D. Richardson
- Department of Emergency MedicineInstitute for Health Equity Research, Population Health Science & Policy, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
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23
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Richie-Zavaleta AC, Villanueva AM, Homicile LM, Urada LA. Compassionate Care-Going the Extra Mile: Sex Trafficking Survivors' Recommendations for Healthcare Best Practices. SEXES 2021; 2:26-49. [PMID: 34485751 PMCID: PMC8415764 DOI: 10.3390/sexes2010003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Human Trafficking (HT) persists in the US, despite multi-level measures designed to mitigate its societal costs. HT instruction for healthcare providers is growing, but there is a dearth of resources and training presenting obstacles for victims accessing suitable healthcare services. Voices of survivors are also scant in the literature, despite the fact that their recommendations would appear essential when designing best practices. This study aimed to methodically gather recommendations from sex trafficking (ST) survivors who sought medical care during their victimization. An exploratory concurrent mixed-methods design was used, and semi-structured interviews (N = 22) were conducted between March 2016 and March 2017, in San Diego, CA, and Philadelphia, PA. Data were analyzed through a coding system to identify meaningful analytical themes. Study participants were recruited through survivor-centered organizations, and their identification was kept anonymous and confidential. Findings included three main themes: (A) Red Flags; (B) supportive healthcare practices; and (C) resources for ST-patient study participants’ recommendations aimed to improve healthcare practice in response to their medical needs in a compassionate and caring manner, with trust building, rapport, and an opportunity to instill hope among ST-patients. Implementing Compassionate Care approaches when caring for ST-patients could positively impact patient–provider interactions, while creating opportunities for intervention.
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Affiliation(s)
- Arduizur C. Richie-Zavaleta
- Department of Public Health, College of Graduate & Professional Studies, University of New England, Portland, ME 04005, USA
- Correspondence: or
| | - Augusta M. Villanueva
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA
| | - Lauren M. Homicile
- Department of Public Health, College of Graduate & Professional Studies, University of New England, Portland, ME 04005, USA
| | - Lianne A. Urada
- School of Social Work, College of Health and Human Services, San Diego State University, San Diego, CA 92182, USA
- School of Medicine, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA
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24
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Wilks L, Robichaux K, Russell M, Khawaja L, Siddiqui U. Identification and Screening of Human Trafficking Victims. Psychiatr Ann 2021. [DOI: 10.3928/00485713-20210706-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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25
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Klein LB, Chesworth BR, Rizo CF, Franchino-Olsen H, Croft C, Macy RJ, Martin SL. Commercial Sexual Exploitation of Children: Indicators and Recommended Inquiries and Responses for Social Workers. SOCIAL WORK 2021; 66:265-268. [PMID: 34151371 DOI: 10.1093/sw/swab017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/15/2019] [Indexed: 06/13/2023]
Affiliation(s)
- L B Klein
- doctoral candidate and graduate research assistant, School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro Street, CB#3550, Chapel Hill, NC 27599
| | | | | | - Hannabeth Franchino-Olsen
- graduate research assistant, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Chris Croft
- prevention education program manager, North Carolina Coalition Against Sexual Assault, Raleigh
| | - Rebecca J Macy
- L. Richardson Preyer distinguished chair for strengthening families and associate dean for research and faculty development, School of Social Work
| | - Sandra L Martin
- professor and associate chair for research, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
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26
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Brenner JM, Blutinger E, Ricke B, Vearrier L, Kluesner NH, Moskop JC. Ethical issues in the access to emergency care for undocumented immigrants. J Am Coll Emerg Physicians Open 2021; 2:e12461. [PMID: 34095898 PMCID: PMC8164497 DOI: 10.1002/emp2.12461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 04/30/2021] [Accepted: 05/05/2021] [Indexed: 11/24/2022] Open
Abstract
Patients who are undocumented immigrants (UIs) frequently present to emergency departments in the United States, especially in communities with large immigrant populations. Emergency physicians confront important ethical issues when providing care for these patients. This article examines those ethical issues and recommends best practices in emergency care for UIs. After a brief introduction and description of the UI population, the article proposes central principles of emergency medical ethics as a framework for emergency physician decisions and actions. It then considers the role of law and public policy in health care for UIs, including the Emergency Medical Treatment and Labor Act, the Patient Protection and Affordable Care Act, and current practices of the US Immigration and Customs Enforcement agency. The article concludes with discussion of the scope of emergency physician practice and with recommendations regarding best practices in ED care for UIs.
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Affiliation(s)
- Jay M. Brenner
- Department of Emergency MedicineSUNY‐Upstate Medical UniversitySyracuseNew YorkUSA
| | - Erik Blutinger
- Department of Emergency MedicineIcahn School of MedicineNew YorkNew YorkUSA
| | - Brandon Ricke
- Department of Emergency MedicineUniversity of KansasKansas CityKansasUSA
| | - Laura Vearrier
- Department of Emergency MedicineUniversity of Mississippi Medical CenterJacksonMississippiUSA
| | | | - John C. Moskop
- Department of Internal MedicineWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
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27
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Salami' T, Gordon M, Babu J, Coverdale J, Nguyen PT. Treatment considerations for foreign-born victims of human trafficking: Practical applications of an ecological framework. Transcult Psychiatry 2021; 58:293-306. [PMID: 33478354 DOI: 10.1177/1363461520983950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Foreign-born individuals immigrating to or residing in the United States are especially vulnerable to exploitation by traffickers. Being trafficked elevates the risk for a variety of physical and mental health problems; thus, victims will often come into contact with health professionals. Because there is a dearth of literature concerning the treatment of human trafficking victims, and especially foreign-born victims, we set out to describe the practical applications of a model that we use for the mental health treatment of victimization in this population. As has been suggested by leaders in the anti-human trafficking community, we employed a culturally sensitive version of Bronfrenbrenner's Ecological Systems Model to provide recommendations and educational resources for treatment at the individual, interpersonal, community, and societal levels. Our recommendations should serve to inform and improve the provision of care for foreign-born victims of human trafficking.
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28
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Recognizing and responding to sex-trafficked minors in the healthcare setting. JAAPA 2021; 33:43-47. [PMID: 32841978 DOI: 10.1097/01.jaa.0000694972.27395.74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Nearly 6,100 reports of sex trafficking were made to the United States Human Trafficking Hotline in 2017; 29% of those reports involved minors. Physician assistants (PAs), especially those working in emergency medicine and primary care, are among the few frequently accessed healthcare providers who have the opportunity for a private conversation with a sex trafficking victim or survivor. PAs must be able to recognize the risk factors and signs of trafficking and respond in a trauma-informed, survivor-centered manner. Connecting trafficking victims, survivors, and at-risk youth with wraparound services is critical to their well-being.
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29
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Kanzaria HK. Leveraging Cross-Sector Data to Address Social Needs in the Emergency Department. Ann Emerg Med 2020; 76:468-469. [DOI: 10.1016/j.annemergmed.2020.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Indexed: 11/16/2022]
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30
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Lawrence M, Bauer P. Knowledge Base of Nurses Before and After a Human Trafficking Continuing Education Course. J Contin Educ Nurs 2020; 51:316-321. [PMID: 32579227 DOI: 10.3928/00220124-20200611-07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/18/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Recent research shows up to 88% of human trafficking victims are seen in a health care setting sometime during their coerced servitude. Nurses are in key positions to identify trafficked victims but often lack sufficient information about how to assess and report trafficked victims. METHOD This article includes participant data from one presurvey and two postsurveys from a human trafficking continuing education course. RESULTS Data demonstrate a precourse knowledge base deficit about human trafficking. The postcourse surveys indicated that participants had increased knowledge and desire to implement the course information to identify trafficked individuals. CONCLUSION Nurses learning about human trafficking through continuing education courses can be invaluable in identifying and helping trafficked victims. [J Contin Educ Nurs. 2020;51(7):316-321.].
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31
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Stoklosa H, Kunzler N, Ma ZB, Luna JCJ, de Vedia GM, Erickson TB. Pesticide Exposure and Heat Exhaustion in a Migrant Agricultural Worker: A Case of Labor Trafficking. Ann Emerg Med 2020; 76:215-218. [PMID: 32362432 DOI: 10.1016/j.annemergmed.2020.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Indexed: 11/24/2022]
Abstract
To our knowledge, there are no published reports of heat exhaustion and pesticide exposure in a labor trafficked patient in the literature. Here we represent the case of J.C.J.L., who was labor trafficked. He presented to a local emergency department with heat exhaustion and pesticide exposure related to working conditions in a Mississippi corn field. Unfortunately, while he received medical treatment, his labor trafficking condition was missed. Emergency departments should be equipped to assess for human trafficking and connect trafficked persons with the resources they need. Emergency physicians should maintain a high index of suspicion for human trafficking among migrant workers presenting with occupation-related complaints.
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Affiliation(s)
- Hanni Stoklosa
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Harvard Humanitarian Initiative, Cambridge, MA
| | - Nathan Kunzler
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Zheng Ben Ma
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | | | - Timothy B Erickson
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Harvard Humanitarian Initiative, Cambridge, MA
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32
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Klingberg K, Stoller A, Müller M, Jegerlehner S, Brown AD, Exadaktylos A, Jachmann A, Srivastava D. Asylum Seekers and Swiss Nationals with Low-Acuity Complaints: Disparities in the Perceived level of Urgency, Health Literacy and Ability to Communicate-A Cross-Sectional Survey at a Tertiary Emergency Department. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082769. [PMID: 32316445 PMCID: PMC7215914 DOI: 10.3390/ijerph17082769] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 12/28/2022]
Abstract
Background: Emergency departments (EDs) are being increasingly used for low-acuity conditions and as primary care providers. Research indicates that patients with the status of asylum seeker (AS) may be seeking care in EDs at higher levels than nationals. The aim of this study was to identify disparities in the use of emergency care between AS and Swiss nationals (SN) with non-urgent complaints. Methods: Data were obtained from a survey in the period 01/12/2016–31/07/2017 of walk-in low-acuity patients attending the ED of the University Hospital Bern (Switzerland). AS and a gender, age-matched control group of SN of ≥16 years of age were included. Sociodemographic and survey data comprised information about health-seeking behavior in the home and reception country, knowledge of health care systems (HCSs), barriers to care and perceived acuity of the visit. Furthermore, attending physicians assessed the level of urgency of each case. Results: Among AS patients, 30.2% reported that they had no knowledge of the Swiss HCS. In total, 14.2% considered that their medical needs were non-urgent. On the other hand, 43.4% of the attending physicians in the ER considered that the medical needs were non-urgent. This contrast was less pronounced in SN patients. The majority of AS (63.2%) and SN (67.6%) patients sought care from the ED without first contacting a GP. In 53.8% of cases, an interpreter was needed during the ED consultation. Conclusions: Several factors associated with health-seeking behavior in the ED differed between AS and SN patients. Measures to increase health literacy, provision of easily accessible primary care services and intercultural-trained staff could improve quality of care and reduce the usage of EDs as primary care providers.
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Affiliation(s)
- Karsten Klingberg
- Emergency Department, University Hospital Bern, 3010 Bern, Switzerland; (K.K.); (A.S.); (M.M.); (S.J.); (A.E.); (A.J.)
| | - Adrian Stoller
- Emergency Department, University Hospital Bern, 3010 Bern, Switzerland; (K.K.); (A.S.); (M.M.); (S.J.); (A.E.); (A.J.)
| | - Martin Müller
- Emergency Department, University Hospital Bern, 3010 Bern, Switzerland; (K.K.); (A.S.); (M.M.); (S.J.); (A.E.); (A.J.)
| | - Sabrina Jegerlehner
- Emergency Department, University Hospital Bern, 3010 Bern, Switzerland; (K.K.); (A.S.); (M.M.); (S.J.); (A.E.); (A.J.)
- Accident & Emergency, Barts Health NHS Trust, London EC1A 7BE, UK
| | - Adam D. Brown
- Department of Psychology, New School of Social Research, New York, NY 10011, USA;
| | - Aristomenis Exadaktylos
- Emergency Department, University Hospital Bern, 3010 Bern, Switzerland; (K.K.); (A.S.); (M.M.); (S.J.); (A.E.); (A.J.)
| | - Anne Jachmann
- Emergency Department, University Hospital Bern, 3010 Bern, Switzerland; (K.K.); (A.S.); (M.M.); (S.J.); (A.E.); (A.J.)
| | - David Srivastava
- Emergency Department, University Hospital Bern, 3010 Bern, Switzerland; (K.K.); (A.S.); (M.M.); (S.J.); (A.E.); (A.J.)
- Correspondence:
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Tiller J, Reynolds S. Human Trafficking in the Emergency Department: Improving Our Response to a Vulnerable Population. West J Emerg Med 2020; 21:549-554. [PMID: 32421500 PMCID: PMC7234705 DOI: 10.5811/westjem.2020.1.41690] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/27/2020] [Indexed: 11/11/2022] Open
Abstract
Human trafficking is a human rights violation affecting millions worldwide. Victims may go unrecognized during their emergency department (ED) visit, and may lose the opportunity to address their complex needs. Using a published toolkit based on existing guidelines and recommendations from experts, and models from other centers, we describe the implementation of an ED response protocol. In following the recommendations of the toolkit, we began with attempts to fully understand the local human trafficking problem and then networked with those working in anti-trafficking efforts. Collaboration with other specialties is highlighted as a key part of this process. Building upon the knowledge gained from these steps, we were able to develop a concise protocol to guide members of our department in more effectively caring for known or suspected victims of human trafficking. The first section of the protocol addresses ways in which providers can identify at-risk patients through both screening questions and general observations. Interviewing techniques are outlined with an emphasis on patient-centered and trauma-informed care. Additionally, the protocol discusses physician responsibility in documenting encounters and legal reporting, which may vary depending on location. We stress the importance of meeting the needs of the patient while prioritizing the safety of all involved. Additionally, the protocol provides a list of resources for the patient beyond medical care such as emergency housing, legal assistance, and food pantries. The overall purpose of this protocol is to provide coordinated response so that all providers may be consistent in caring for this vulnerable population.
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Affiliation(s)
- Jennifer Tiller
- Levine Children's Hospital and Carolinas Medical Center, Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Charlotte, North Carolina
| | - Stacy Reynolds
- Levine Children's Hospital and Carolinas Medical Center, Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Charlotte, North Carolina
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Geiderman JM, Marco CA. Mandatory and permissive reporting laws: obligations, challenges, moral dilemmas, and opportunities. J Am Coll Emerg Physicians Open 2020; 1:38-45. [PMID: 33000012 PMCID: PMC7493571 DOI: 10.1002/emp2.12011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/03/2019] [Accepted: 12/10/2019] [Indexed: 11/13/2022] Open
Abstract
The duty to report certain conditions to public health or law enforcement authorities is one that falls on all physicians and other health care workers as part of their duty to protect the public from harm. In an open society, others, such as teachers, clergy, police officers, or simply neighbors, share the responsibility of protecting individuals at risk, often by reporting them to authorities. The emergency physician and others in the emergency department are uniquely positioned to identify people at risk or who pose a risk, and to report them as required or allowed under the law. In some circumstances, these duties may conflict with ethical duties such as respect for patient autonomy or to protect confidentiality. This article will examine mandatory and permissive reporting laws in various states from an ethical perspective. It will also explore emerging issues such as the reporting of suspected human trafficking.
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Affiliation(s)
- Joel M. Geiderman
- Ruth and Harry Roman Emergency DepartmentDepartment of Emergency Medicineand Center for Healthcare EthicsBurns and Allen Research InstituteCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Catherine A. Marco
- Department of Emergency MedicineWright State University Boonshoft School of MedicineDaytonOhioUSA
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Lavoie J, Dickerson KL, Redlich AD, Quas JA. Overcoming Disclosure Reluctance in Youth Victims of Sex Trafficking: New Directions for Research, Policy, and Practice. PSYCHOLOGY, PUBLIC POLICY, AND LAW : AN OFFICIAL LAW REVIEW OF THE UNIVERSITY OF ARIZONA COLLEGE OF LAW AND THE UNIVERSITY OF MIAMI SCHOOL OF LAW 2019; 25:225-238. [PMID: 32103880 PMCID: PMC7043240 DOI: 10.1037/law0000205] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
An alarming number of youth worldwide are victims of commercial sexual exploitation, particularly sex trafficking. Normative developmental processes and motivations across the adolescent period-the age when youth are at greatest risk for trafficking-combined with their history, make them highly likely to be reluctant to disclose their exploitation to police, who often encounter victims because they are suspected of delinquency and crime and who interrogate the victims as suspects. Little scientific and policy attention has been devoted to understanding how to question these victims in a way that reduces their disclosure reluctance and increases their provision of legally relevant information. In the current review, we describe research concerning trafficking victims' histories and exploitative experiences, juvenile suspects' and victims' encounters with the legal system, and best-practice forensic interviewing approaches to elicit disclosures from child victims. We highlight the implications of these areas for understanding the dynamics between how police encounter and interact with adolescent trafficking victims and whether and how the victims disclose trafficking details during these interactions. We close with an agenda for research to test interviewing methods for suspected victims of sex trafficking and with policy and practice recommendations for interviewers.
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Affiliation(s)
| | - Kelli L Dickerson
- Department of Psychological Science, University of California, Irvine
| | | | - Jodi A Quas
- Department of Psychological Science, University of California, Irvine
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Samra S, Taira BR, Pinheiro E, Trotzky-Sirr R, Schneberk T. Undocumented Patients in the Emergency Department: Challenges and Opportunities. West J Emerg Med 2019; 20:791-798. [PMID: 31539336 PMCID: PMC6754205 DOI: 10.5811/westjem.2019.7.41489] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 07/01/2019] [Indexed: 11/11/2022] Open
Abstract
In the United States, undocumented residents face unique barriers to healthcare access that render them disproportionately dependent on the emergency department (ED) for care. Consequently, ED providers are integral to the health of this vulnerable population. Yet special considerations, both clinical and social, generally fall outside the purview of the emergency medicine curriculum. This paper serves as a primer on caring for undocumented patients in the ED, includes a conceptual framework for immigration as a social determinant of health, reviews unique clinical considerations, and finally suggests a blueprint for immigration-informed emergency care.
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Affiliation(s)
- Shamsher Samra
- Harbor-UCLA Medical Center, Department of Emergency Medicine, Torrance, California
| | - Breena R Taira
- Olive View-UCLA Medical Center, Department of Emergency Medicine, Sylmar, California
| | | | - Rebecca Trotzky-Sirr
- LAC-USC Medical Center, Department of Emergency Medicine, Los Angeles, California
| | - Todd Schneberk
- LAC-USC Medical Center, Department of Emergency Medicine, Los Angeles, California
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Richie-Zavaleta AC, Villanueva A, Martinez-Donate A, Turchi RM, Ataiants J, Rhodes SM. Sex Trafficking Victims at Their Junction with the Healthcare Setting-A Mixed-Methods Inquiry. ACTA ACUST UNITED AC 2019; 6:1-29. [PMID: 32190715 DOI: 10.1080/23322705.2018.1501257] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
U.S.-born citizens are victims of human trafficking typically exploited through sex trafficking. At least some of them interact with healthcare providers during their trafficking experience; yet a majority goes unidentified. Although protocols and training guides exist, healthcare providers often do not have the necessary skills to identify and assist victims of sex trafficking. Understanding where victims seek care and barriers for disclosure are critical components for intervention. Thus, this study interviewed survivors of sex trafficking to ascertain: a) healthcare settings visited during trafficking, b) reasons for seeking care, and c) barriers to disclosing victimization. An exploratory concurrent mixed-methods approach was utilized. Data were collected between 2016-2017 in San Diego, CA and Philadelphia, PA (N = 21). Key findings: 1) Among healthcare settings, emergency departments (76.2%) and community clinics (71.4%) were the most frequently visited; 2) medical care was sought mainly for treatment of STIs (81%); and 3) main barriers inhibiting disclosure of victimization included feeling ashamed (84%) and a lack of inquiry into the trafficking status from healthcare providers (76.9%). Healthcare settings provide an opportunity to identify victims of sex trafficking, but interventions that are trauma-informed and victim-centered are essential. These may include training providers, ensuring privacy, and a compassionate-care approach.
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Affiliation(s)
- Arduizur Carli Richie-Zavaleta
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Augusta Villanueva
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Ana Martinez-Donate
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Renee M Turchi
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Janna Ataiants
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Shea M Rhodes
- Institute to Address Commercial Sexual Exploitation, Villanova University Charles Widger School of Law, Villanova, PA, USA
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Berishaj K, Buch C, Glembocki MM. The Impact of an Educational Intervention on the Knowledge and Beliefs of Registered Nurses Regarding Human Trafficking. J Contin Educ Nurs 2019; 50:269-274. [PMID: 31136670 DOI: 10.3928/00220124-20190516-07] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 11/27/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Human trafficking is a global, public health concern that can be addressed by nurses. The purpose of this pilot study was to determine the effect of an educational intervention on nurses' self-reported knowledge and beliefs regarding human trafficking. METHOD A quasi-experimental, pretest-posttest design was used to determine whether the implementation of an educational intervention had a positive impact on nurses' self-reported knowledge and beliefs regarding human trafficking. Researchers developed a survey instrument to evaluate attainment of outcomes. RESULTS The survey instrument was found to be highly reliable on both pretest (α = .90) and posttest (α = .81). The paired sample t-test results showed a significant change (p < .001) in nurses' perceived knowledge and beliefs from pretest to posttest for 17 of 19 survey items. CONCLUSION An educational conference is an effective intervention that can positively affect nurses' perceptions of knowledge and beliefs regarding human trafficking. [J Contin Educ Nurs. 2019;50(6):269-274.].
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Acharya AK. Prevalence of violence against indigenous women victims of human trafficking and its implications on physical injuries and disabilities in Monterrey city, Mexico. Health Care Women Int 2019; 40:829-846. [DOI: 10.1080/07399332.2018.1564612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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40
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Identifying Sexual and Labor Exploitation among Sheltered Youth Experiencing Homelessness: A Comparison of Screening Methods. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16030363. [PMID: 30696049 PMCID: PMC6388175 DOI: 10.3390/ijerph16030363] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 01/21/2019] [Accepted: 01/24/2019] [Indexed: 11/16/2022]
Abstract
Human trafficking is a significant and growing public health concern. Subgroups of adolescents and young adults are particularly vulnerable to human trafficking, especially youth who are unstably housed or homeless. While youth experiencing trafficking come into contact with the healthcare system, they are often not identified during routine assessment due to lack of specific inquiry and low disclosure. Therefore, we utilized a mixed-methods study design to assess the differences in the identification of human trafficking among youth experiencing homelessness (n = 129) between a standard psychosocial assessment tool and a human trafficking specific assessment tool. Findings indicate that the tool developed to specifically assess for human trafficking was more likely to identify youth experiencing sexual and labor exploitation, as well as the risk factors for human trafficking. Secondly, youth reported that mistrust of the system, fear of involving the police if reported, not wanting to interact with the mental healthcare system, and stigma are barriers to disclosing human trafficking. In conclusion, healthcare providers caring for youth experiencing homelessness should adopt improved screening tools for human trafficking to reduce the risk of missed opportunities for prevention and treatment among this high-risk population of youth.
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Emergency Department Documentation of Alleged Police Use of Excessive Force in Cases Where Formal Complaints Are Ultimately Filed. ACTA ACUST UNITED AC 2018; 39:309-311. [DOI: 10.1097/paf.0000000000000418] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hadjipanayis A, Crawley FP, Stiris T, Neubauer D, Michaud PA. Child trafficking in Europe: what is the paediatrician's role? : A statement by the European Academy of Paediatrics. Eur J Pediatr 2018; 177:1419-1423. [PMID: 29946856 DOI: 10.1007/s00431-018-3190-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 06/01/2018] [Accepted: 06/06/2018] [Indexed: 11/29/2022]
Abstract
UNLABELLED Child trafficking is among the most lucrative criminal activities in the world and growing rapidly. Poverty, natural disasters, armed conflicts and, in particular, migration put vulnerable children at high risk of trafficking. Accurate statistics on child trafficking are not available due to its illegal nature. Moreover, trafficking may not be consistently recorded and reported by European countries, mainly because of different perceptions as to who is considered a victim of trafficking. Around 4000-5000 children were identified as presumed victims of trafficking in European Union countries from 2013 to 2014; this is an underestimate of the problem because many victims go unrecognised. Trafficking is linked with issues, such as forced marriage, begging, labour or domestic servitude, slavery and prostitution as well as sexual abuse and child pornography. It may also involve the use of children as soldiers or for criminal activities, such as theft and drug smuggling. Child trafficking also involves the removal of organs and the selling neonates, infants, and children for adoption. Child victims of trafficking should be promptly identified in order to provide them with the necessary care as well as to prosecute the traffickers and stop their illegal activity. Healthcare professionals should be appropriately trained to keep a careful eye out for any signs of trafficking in children. CONCLUSION The European Academy of Paediatrics calls on our governments, intergovernmental organisations, paediatricians, and healthcare professionals to collaborate so as to improve the identification and healthcare of victims and to contribute to the disbanding and prosecution of child traffickers by reporting such situations. What is Known: • Child trafficking is a fast growing and among the most lucrative criminal activities in the world. • Poverty, natural disasters, armed conflicts and in particular migration put vulnerable children at high risk of trafficking. What is New: • Child trafficking is an underestimated and often ignored issue, with around 4000-500children identified as presumed victims in European Union countries from 2013 to 2014. • The European Academy of Paediatrics strongly encourages Paediatricians to identify victims as well as provide them with adequate health care and support; it calls on governments, intergovernmental organisations, and fellow compatriots to act within the full extent of the law to identify, disband, and prosecute child traffickers.
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Affiliation(s)
- Adamos Hadjipanayis
- Department of Paediatrics, Larnaca General Hospital, Larnaca, Cyprus. .,Medical School, European University of Cyprus, Nicosia, Cyprus. .,European Academy of Paediatrics, Brussels, Belgium.
| | - Francis P Crawley
- European Academy of Paediatrics, Brussels, Belgium.,Good Clinical Practice Alliance - Europe (GCPA), Brussels, Belgium
| | - Tom Stiris
- European Academy of Paediatrics, Brussels, Belgium.,Department of Neonatology, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - David Neubauer
- European Academy of Paediatrics, Brussels, Belgium.,Department of Child, Adolescent & Developmental Neurology, University Children's Hospital, Ljubljana, Slovenia
| | - Pierre-André Michaud
- European Academy of Paediatrics, Brussels, Belgium.,Faculty of Biology & Medicine, University of Lausanne, Lausanne, Switzerland
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What Therapies are Favored in the Treatment of the Psychological Sequelae of Trauma in Human Trafficking Victims? J Psychiatr Pract 2018; 24:87-96. [PMID: 29509178 DOI: 10.1097/pra.0000000000000288] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Human trafficking is a major public health concern that brings about deleterious psychological consequences and sequelae. Although a number of risk and protective factors for the health consequences of human trafficking victims have been identified, there is a dearth of information in the area of treatment. Specifically, we found no articles comparing the different components of prevailing trauma treatment strategies, and the potential usefulness of these strategies in the treatment of human trafficking victims. To this end, we compared and contrasted the different therapeutic treatments typically implemented with victims of trauma (including domestic violence victims and torture victims), and discussed how the different components of these treatments may or may not be helpful for human trafficking victims. We assessed the impact of these treatments on the psychological consequences of trauma and, in particular on posttraumatic stress disorder. We also assessed the potential usefulness of these treatments with co-occurring problems such as substance use, psychosis, dissociation, and other mood and anxiety disorders. On the basis of the prevailing research, we highlighted cognitive therapies as being preferred in addressing the needs of human trafficking victims. Mental health providers who work with human trafficking victims should become aware of and practiced in the use of cognitive therapeutic approaches in treating this population. Efficacy and effectiveness studies are needed to validate our recommendations.
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Trafficking and Trauma: Insight and Advice for the Healthcare System From Sex-trafficked Women Incarcerated on Rikers Island. Med Care 2017; 55:1017-1022. [PMID: 28945674 DOI: 10.1097/mlr.0000000000000820] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sex-trafficked persons experience significant trauma while exploited, resulting in complex health issues and barriers to health care. Incorporating survivor perspectives is critical in optimizing health care delivery for this population. OBJECTIVES We interviewed sex-trafficking survivors regarding their experiences with trauma while being trafficked and elicited advice about health care delivery. RESEARCH DESIGN Qualitative interviews were conducted in New York City's Rikers Island jail from July to September 2015. SUBJECTS In total, 21 English-speaking women who had experienced sex trafficking were the subjects of the study. MEASURES Interview domains included: interpersonal violence, behavioral health, and health care delivery advice. RESULTS Interviewees described experiencing severe and chronic trauma perpetrated by traffickers and sex buyers. Substance use was the primary method of coping with trauma. With regard to mental health, interviewees noted diagnoses of depression, anxiety and posttraumatic stress disorder, low self-esteem, and challenges in intimate relationships. Health care delivery themes included approaches to discussing trafficking in health care settings, concerns regarding sexual assault examinations, and suggestions for improving direct-services and prevention programming. CONCLUSIONS With this perspective into the complex intersection of trauma and behavioral health that sex-trafficked women can experience, health care providers can better understand the context and recommendations regarding trauma-informed care practices for this population. Our results also offer several avenues for future studies with regard to discussing trafficking in clinical settings and an opportunity for stakeholders to incorporate survivor-based input to improve health care for this population.
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Child trafficking and the European migration crisis: The role of forensic practitioners. Forensic Sci Int 2017; 282:46-59. [PMID: 29154142 DOI: 10.1016/j.forsciint.2017.10.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 10/27/2017] [Accepted: 10/27/2017] [Indexed: 11/20/2022]
Abstract
Trafficking in children is one of the worst forms of human rights violation and is categorised as a serious crime. Children at high risk of becoming victims of trafficking are runaways, children with a history of abuse, and migrant children. Internationally, cases of child trafficking are increasing the most in Europe, which is likely the result of the current migration crisis. In crises, preventing and combating human trafficking needs to be prioritized, considering that the aims of humanitarian action include saving lives, easing suffering and preserving human dignity. The involvement of forensic practitioners in investigations of cases of child trafficking mainly concerning the identification of victims may save lives and certainly alleviate suffering of the child victims and their families searching for them. Moreover, by aiding the prosecution process through thorough documentation and expert reporting forensic practitioners may contribute to the protection, rehabilitation and possibly compensation of the child victims, and thus to the restoration of their rights and dignity. So far, forensic practitioners were rarely specifically mentioned as actors in the counter-trafficking efforts in the multitude of policies, regulations, guidelines and recommendations concerning different aspects of child trafficking. This seems surprising considering that the expertise and experience of practitioners from forensic sciences including cyber forensics, document analysis, forensic biology, anthropology, and medicine can be utilised for gathering intelligence in cases of suspected human trafficking, for identifying the victims as well as perpetrators, and for securing evidence for legal proceedings as this paper shows. While this article mainly discusses the role of forensic pathologists and anthropologists, with a specific focus on the identification of child victims of trafficking in the context of the European migration crisis, the notions regarding the contribution of forensic sciences to the counter-trafficking efforts can be adapted to other geographical and sociopolitical contexts.
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Thompson CD, Mahay A, Stuckler D, Steele S. Do clinicians receive adequate training to identify trafficked persons? A scoping review of NHS Foundation Trusts. JRSM Open 2017; 8:2054270417720408. [PMID: 28904806 PMCID: PMC5588808 DOI: 10.1177/2054270417720408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objective We investigate whether physicians in secondary care in the English NHS receive adequate training to recognise and appropriately refer for services those persons suspected to be victims of human trafficking. Design Freedom of Information requests were sent to the 105 England’s NHS Trusts delivering acute care in England. Setting NHS Trusts providing secondary care in England. Participants English NHS Trusts. Main outcome measures We requested data about the training provided on human trafficking to clinicians, including the nature, delivery, and format of any education, and any planned training. Results A total of 89.5% of the 105 Trusts responded. Of these Trusts, 69% provide education to physicians on human trafficking, and a further 6% provide training but did not specify who received it. The majority of Trusts providing training did so within wider safeguarding provision (91%). Only one trust reported that it provides stand-alone training on trafficking to all its staff, including physicians. Within training offered by Trusts, 54% observed best practice providing training on the clinical indicators of trafficking, while 16% referenced the National Referral Mechanism. Amongst those not providing training, 39% of Trusts report provision is in development. Conclusions Our results find that 25% of NHS Foundation Trusts appear to lack training for physicians around human trafficking. It is also of concern that of the Trusts who currently do not provide training, only 39% are developing training or planning to do so. There is an urgent need to review and update the scope of available training and bring it into alignment with current legislation.
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Affiliation(s)
| | - Arun Mahay
- Barts and The London School of Medicine and Dentistry, London E1 2AT, UK
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Affiliation(s)
- James A. Levine
- Health Solutions, Mayo Clinic Arizona and Arizona State University, Suite 200 CRB, 13400 East Shea Blvd, Scottsdale, AZ 85259, USA
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50
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Powell C, Dickins K, Stoklosa H. Training US health care professionals on human trafficking: where do we go from here? MEDICAL EDUCATION ONLINE 2017; 22:1267980. [PMID: 28178913 PMCID: PMC5328372 DOI: 10.1080/10872981.2017.1267980] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 07/21/2016] [Accepted: 11/29/2016] [Indexed: 05/31/2023]
Abstract
UNLABELLED Some 21 million adults and children are labor-trafficked or sex-trafficked through force, fraud, or coercion. In recognition of the interface between trafficking victims and the healthcare setting, over the last 10 years there has been a notable increase in training of health care professionals (HCPs) on human trafficking (HT) and its health implications. Many organizations have developed curricula and offered training in various clinical settings. However, methods and content of this education on trafficking vary widely, and there is little evaluation of the impact of the training. The goal of this study was to assess the gaps and strengths in HT education of HCPs in the US. This mixed-method study had two components. The first component consisted of structured interviews with experts in human trafficking HCP education. The second portion of the study involved an analysis of data from HCP calls to the National Human Trafficking Resource Center (NHTRC). The interviews captured trainer-specific data on types of HT training, duration and frequency, key content areas, presence of evaluation approaches and indicators, as well as an assessment of barriers and strengths in HT training for HCP. NHTRC call database analysis demonstrated increasing trends since 2008 in calls by HCPs. Overall findings revealed the need for standardization of HT training content to assure correct information, trauma-informed and patient-centered care, and consistent messaging for HCPs. Evaluation metrics for HT training need to be developed to demonstrate behavior change and impact on service delivery and patient-centered outcomes for HT victims, according to our proposed adapted Kirkpatrick's Pyramid model. HT training and evaluation would benefit from an agency or institution at the national level to provide consistency and standardization of HT training content as well as to guide a process that would develop metrics for evaluation and the building of an evidence base. ABBREVIATIONS AAP: American Academy of Pediatrics; ACF: Administration for Children and Families; CME: Continuing medical education; ED: Emergency department; HCP: Health care professional; HEAL: Health, Education, Advocacy, and Linkage; HHS: United States Department of Health and Human Services; HT: Human trafficking; IOM: United States Institute of Medicine; MH: Mental health; NHTRC: National Human Trafficking Resource Center; SOAR: Stop, Observe, Ask, and Respond to Health and Wellness Training.
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Affiliation(s)
- Clydette Powell
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | - Hanni Stoklosa
- Department of Emergency Medicine, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA
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