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Benavente B, Bully P, Ballester L. Instruments for the Identification of Child Sexual Exploitation: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2024; 25:2204-2218. [PMID: 37997288 DOI: 10.1177/15248380231207898] [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: 11/25/2023]
Abstract
To perform a systematic search of instruments for the early identification of risk of sexual exploitation in children (CSE) and appraise their metric properties. Searches were conducted in four electronic databases to identify instruments that only evaluated child sexual exploitation with no restrictions of date or language. Two reviewers independently carried out the initial selection of titles and abstracts, appraisal of the methodological quality, compliance with the entry criteria in the analysis, and extraction of data necessary to systematize the information available. Twenty-three articles were found that used 15 CSE detection instruments. The instruments varied with regard to number of questions, ease of administration, sources of information, rating methods, and the training information provided. What they had in common is that most were designed and used in the English-speaking world, basically in the United States, with few instruments providing solid proof of their validity and reliability in the scores derived thereof. Although instruments were obtained with significant similarities in their conceptualization, differences in multiple characteristics made it difficult to draw clear conclusions regarding their greater or lesser suitability. What did become clear was the need to keep working on obtaining rigorous empirical psychometric evidence.
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Affiliation(s)
| | - Paola Bully
- Paola Bully Methodological and Statistical Consultancy, Bilbao, País Vasco, Spain
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2
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Balasa R, Khan M, Gesink D, Forman L, Perez-Brumer A. Experiences of child sex trafficking identification among Ontario pediatric emergency department healthcare providers: A qualitative study. CHILD ABUSE & NEGLECT 2024; 153:106852. [PMID: 38776630 DOI: 10.1016/j.chiabu.2024.106852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 04/02/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND AND OBJECTIVE More than 60 % of people exposed to sex trafficking access hospital emergency departments (ED), making the ED a critical setting for child sex trafficking identification. Children exposed to sex trafficking (CEST) do not always recognize that they are being exploited. With many ED leaders confirming that there are no formal processes or assessment tools to screen for human trafficking in EDs, it is especially challenging for healthcare providers to identify CEST. Accordingly, the following study sought to examine healthcare providers' child sex trafficking identification practices in Ontario pediatric EDs. METHODS We conducted interviews with healthcare providers (N = 12) who work in an Ontario pediatric ED and have provided services to CEST. Thematic analysis and intersectionality theory guided our analytic approach. RESULTS Participants underscored the key role of Registered Nurses for identifying presentations of child sex trafficking in Ontario pediatric EDs. Although white, feminine presenting youth are the predominantly identified demographic of CEST in Ontario pediatric EDs, healthcare providers also described key intersections between race, poverty, child welfare agency system involvement, and adverse childhood life experiences as factors that heightened vulnerability to child sex trafficking. Common presentations to the ED were for non-specific concerns, injuries, following a sexual assault, or for mental health concerns. Suggested methods for identification varied but were centred around the principles of trauma- and violence-informed care. CONCLUSION Identifying child sex trafficking in Ontario pediatric EDs is a complex practice, requiring human trafficking training and education for healthcare providers. The interrelated indicators of child sex trafficking, including the sociodemographic and clinical profile of the patient, must be considered jointly, using a trauma- and violence-informed approach.
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Affiliation(s)
- Rebecca Balasa
- University of Toronto, Dalla Lana School of Public Health, Canada.
| | - Momina Khan
- University of Toronto, Dalla Lana School of Public Health, Canada
| | - Dionne Gesink
- University of Toronto, Dalla Lana School of Public Health, Canada
| | - Lisa Forman
- University of Toronto, Dalla Lana School of Public Health, Canada
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3
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Nhep R, Deck S, van Doore K, Powell M. Detecting orphanage trafficking and exploitation. CHILD ABUSE & NEGLECT 2024; 152:106813. [PMID: 38657489 DOI: 10.1016/j.chiabu.2024.106813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/08/2023] [Accepted: 04/19/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND There is growing awareness that a proportion of children in orphanages have been recruited or transferred into the facility for a purpose of exploitation and/or profit. These children are often falsely presented as orphans to evoke sympathy and solicit funding. This process is known as orphanage trafficking. Although orphanage trafficking can be prosecuted under legal frameworks in some jurisdictions, including Cambodia, there have been limited prosecutions to date. One factor that likely contributes to a lack of prosecution is poor detection, yet the indicators of orphanage trafficking have not been considered by extant research. OBJECTIVE The current study was conducted as a first step towards providing evidence-based indicators of orphanage trafficking. PARTICIPANTS AND SETTING Professionals who had identified or responded to cases of orphanage-based exploitation in Cambodia were interviewed. Participants included criminal justice professionals, investigators from civil society organisations, and child protection social workers. METHODS Professionals' perspectives on how to identify orphanage trafficking were explored via in-depth interviews, and the data were analysed via thematic analysis. RESULTS The analysis revealed a distinct set of indicators that may be used to detect orphanage trafficking, including the operation of an unauthorised facility, orphanage tourism and volunteering, and an overt focus on fundraising. CONCLUSION The indicators revealed in this study point to the need for an effective and thorough monitoring system for orphanages, as well as adequate education and training of relevant personnel to aid in the detection of orphanage trafficking.
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Affiliation(s)
- Rebecca Nhep
- Better Care Network, New York, USA; Law Futures Centre, Griffith University, Queensland, Australia.
| | - Sarah Deck
- Centre for Investigative Interviewing, Griffith University, Queensland, Australia.
| | - Kate van Doore
- Law Futures Centre, Griffith University, Queensland, Australia.
| | - Martine Powell
- Centre for Investigative Interviewing, Griffith University, Queensland, Australia.
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Kim BKE, Dierkhising CB, De Leon J, Sandoval J, Brissett A, Bounds D. Evaluation of Services for the Commercial Sexual Exploitation of Children and Youth: A Scoping Review. TRAUMA, VIOLENCE & ABUSE 2023; 24:3236-3250. [PMID: 36197082 DOI: 10.1177/15248380221126185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Commercial sexual exploitation (CSE) of youth is a public health issue with multiple negative consequences. Despite the complexities and comprehensiveness of service needs for youth experiencing CSE, the evidence base of effective services and programs lags far behind. This scoping review seeks to identify the most up-to-date evidence on programs for youth experiencing CSE that have been evaluated and found to be effective. We conducted a scoping review of current literature, including peer-reviewed articles as well as gray literature using a scientific approach to identify programs and service provisions specifically focused on youth experiencing CSE and examine empirical evidence for their effectiveness. A comprehensive search of five databases was completed in September 2020 then updated in April 2021 to identify relevant publications from January 1, 2000 to present. Additional program mining was conducted on evaluations of programs mentioned in the search results. A total of 3,597 citations from the database searches were screened for title and abstract and 190 citations were included for full-text review. The search process yielded 11 eligible articles with one additional report found through program mining. Identified programs targeted youth, providers, and consumers of CSE. While scientific rigor was not high, all included studies reported positive outcomes. Evidence base for effective services and programs is sparse. While more programs and services are being developed, studies should use rigorous research designs to test the effectiveness of these programs and services. Implications for practice and policy are discussed.
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Chen VH, Beauchemin EL, Cuan IT, Sadana A, Olulola-Charles L, Leschi JE, Ades V. Sex Trafficking in New York City and Vulnerabilities to Re-Trafficking. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:11501-11519. [PMID: 37421223 DOI: 10.1177/08862605231183452] [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: 07/10/2023]
Abstract
Human trafficking occurs in a cycle of coercion and exploitation of vulnerable people; yet, little is known about those who are trafficked more than one time (re-trafficked). Our study sought to describe the trafficking experiences and explore vulnerabilities to re-trafficking in an urban, majority immigrant, population. This study is part of a parent cohort study that enrolls patients at the EMPOWER Center in New York City, which provides trauma-informed obstetric and gynecologic services to victims of sexual- and gender-based violence. Retrospective chart review was conducted on patients with a history of sex trafficking who were evaluated at the EMPOWER Center from February 2013 to January 2021. A total of 87 patients were enrolled in this study, 23 (26.4%) of whom had been re-trafficked. All were women. Most (88.5%) were victims of international trafficking, most often from Mexico or the Caribbean/Central America. Nine (10.3%) reported contraceptive use and six (6.9%) experienced forced substance use while trafficked. The most reported barriers that women faced in escaping trafficking were threat of violence (28.7%) and financial dependence (19.5%). Re-trafficked patients were more likely to have a history of being undocumented (odds ratio [OR] = 5.29; 95% confidence intervals [CI] [1.34, 20.94]) and experienced childhood sexual abuse (OR = 2.99; 95% CI [1.10, 8.16]), experienced childhood physical abuse (OR = 3.33; 95% CI [1.18, 9.39]), and lived with a non-parent family member (OR = 6.56; 95% CI [1.71, 25.23]). Although these vulnerabilities were no longer significant when analyzed in a parsimonious multivariate logistic regression model adjusting for the other significant variables, likely due to the limited sample size. Almost half (46.0%) reported ongoing emotional effects from being trafficked, which did not vary by re-trafficking status. Our study highlights potential pre-trafficking vulnerabilities, illustrates the complexity of the trafficking experience, and presents potential risk factors for being re-trafficked.
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Affiliation(s)
| | | | | | - Annum Sadana
- New York University Grossman School of Medicine, NY, USA
| | | | - Julia E Leschi
- New York University Steinhardt School of Culture, Education, and Human Development, NY, USA
| | - Veronica Ades
- New York University Grossman School of Medicine, NY, USA
- Department of Obstetrics & Gynecology, Jacobi Medical Center, Bronx, NY, USA
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA
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Laird JJ, Klettke B, Hall K, Hallford D. Toward a Global Definition and Understanding of Child Sexual Exploitation: The Development of a Conceptual Model. TRAUMA, VIOLENCE & ABUSE 2023; 24:2243-2264. [PMID: 35603675 DOI: 10.1177/15248380221090980] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Child sexual exploitation (CSE) is a serious and persistent global issue affecting up to 5% of the child and youth population worldwide; yet there is no universally accepted definition. To develop a theoretically robust definition of CSE, this review systematically synthesized literature examining CSE definitions aiming to develop a conceptual model and typology. Electronic databases were searched to February 2021, yielding 384 nonduplicative records. Inclusion criteria were peer-reviewed and grey literature investigations of sexual exploitation, with a mean sample age of 18 years or younger, available in the English language. Literature review and data extraction followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Sixty-six studies met final inclusion criteria. Two independent reviewers extracted relevant data and used an epistemological approach to thematically analyse meaning and patterns across CSE definitions. Key findings demonstrate that CSE nomenclature is widely inconsistent, and despite growing awareness of this severe form of abuse, language continues to perpetuate stigma and criminalisation, utilising terms such as 'adolescent or child prostitute'. Our findings propose a scientifically and trauma-informed definition and conceptualisation of CSE, based on the following four-dimensional components: (1) A child/young person; (2) sexual acts; (3) abuse; and (4) exploitation (abuse + exchange). In this systematic review, a unified definition and conceptual model aims to advance knowledge and understanding of CSE, contributing to the progression of social norms which embrace nuances of trauma-informed practice and support for the identification and recovery of children, young people and families affected by sexual exploitation.
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Affiliation(s)
- Jessica J Laird
- School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Bianca Klettke
- School of Psychology, Deakin University, Geelong, VIC, Australia
- Center for Social and Early Emotional Development, Deakin University, Burwood, VIC, Australia
| | - Kate Hall
- School of Psychology, Deakin University, Geelong, VIC, Australia
- Addictive and Anti-social behavior Research, Deakin University Centre for Drug Use, Burwood, VIC, Australia
| | - David Hallford
- School of Psychology, Deakin University, Geelong, VIC, Australia
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Hornor G, Hollar J, Landers T, Sherfield J. Healthcare Use and Case Characteristics of Commercial Sexual Exploitation of Children: Teen Victims Versus High-Risk Teens. JOURNAL OF FORENSIC NURSING 2023; 19:160-169. [PMID: 37590938 DOI: 10.1097/jfn.0000000000000402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The overall goal of this study was to provide further information about the characteristics of commercial sexual exploitation of children (CSEC) victims by comparing the characteristics of a known victim pool to high-risk patients identified. The specific objectives of this study were to describe patient demographic characteristics, pediatric healthcare use, familial psychosocial characteristics, and child sexual abuse case characteristics present in youth identified as high risk for CSEC victimization compared with a sample of known victims. METHODS A retrospective chart review was conducted on patients presenting to the emergency department or Child Advocacy Center for a concern of sexual abuse/assault at a midwestern U.S. academic pediatric medical center. Adolescents aged 12-21 years were included in the study. RESULTS In the current study, multiple CSEC risk factors were noted to increase odds for CSEC victimization: homelessness or life on the streets, runaway behavior, living with mother only, placement in a juvenile detention center, placement in a residential treatment center or group home, and number of living arrangements (four or greater). Multiple elements of high-risk sexual behavior increased odds of CSEC victimization: legally age-inappropriate sex, gonorrhea diagnosis, trichomonas diagnosis, other sexually transmitted infection (STI) diagnoses, number of STIs, and chlamydia diagnosis. DISCUSSION These findings suggest that age of sexual partners and number and types of STIs are associated with CSEC and should be validated in other groups. In addition, these data suggest that use of cocaine and opiates could serve as an important, yet underrecognized, risk factor.
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Affiliation(s)
- Gail Hornor
- Author Affiliations: International Association of Forensic Nurses
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Raker KA. An examination of nurse educators' Knowledge, Attitudes, Instructional Beliefs, and Instructional Practices of human trafficking. J Prof Nurs 2023; 47:35-45. [PMID: 37295911 DOI: 10.1016/j.profnurs.2023.04.002] [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: 09/03/2022] [Revised: 04/01/2023] [Accepted: 04/10/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Delivering human trafficking education to nursing students may improve graduates' ability to identify and assist persons victimized by trafficking. A paucity of research has examined human trafficking as a content area in academic nursing programs as well as nurse educators' understanding and teaching practices of human trafficking. PURPOSE This study sought to (a) describe nurse educators' perceived knowledge, actual knowledge, attitudes, instructional beliefs, and instructional practices of human trafficking; (b) determine if differences in actual knowledge, attitudes, and instructional beliefs of human trafficking exist among nurse educators who have experience teaching about human trafficking compared to nurse educators who have never taught about human trafficking; and (c) determine if differences in actual knowledge, attitudes, and instructional beliefs exist among nurse educators who have received human trafficking training compared to nurse educators who have not received human trafficking training. METHOD A descriptive, cross-sectional study was conducted using survey methodology. A nationwide sample of 332 academic nurse educators was analyzed. RESULTS Findings among nurse educators included low perceived knowledge levels and strong actual knowledge levels about human trafficking. Participants held awareness they may encounter trafficked individuals in the workplace and expressed responsibility to respond to suspected cases. However, participants reported having received insufficient training on the topic and low confidence responding to trafficking situations. While nurse educators find relevance and value in teaching students about human trafficking, most do not have personal experience teaching about human trafficking or feel confident teaching on the topic. CONCLUSION This study provides preliminary knowledge of nurse educators' understanding and teaching practices of human trafficking. Findings from this study offer implications for nurse educators and program administrators to improve human trafficking training among nursing faculty and integrate human trafficking education into curricula.
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Affiliation(s)
- Katherine A Raker
- Indiana University of Pennsylvania, 1011 South Drive, Indiana, PA 15705, United States.
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Kachelski C, Hansen J, Moffatt ME, Arends G, Sherman A, Anderst J. Comparative healthcare use by adolescents screening positive for sexual exploitation. CHILD ABUSE & NEGLECT 2023; 141:106201. [PMID: 37146540 DOI: 10.1016/j.chiabu.2023.106201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/03/2023] [Accepted: 04/14/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Although screens for commercial sexual exploitation of children (CSEC) have been developed, little is known about how adolescents at high risk for, or victims of, CSEC compared to non-CSEC adolescents in healthcare utilization as previous studies have not included a control group. OBJECTIVE Identify where and how often CSEC adolescents presented to medical care in 12 months prior to being identified as compared to non-CSEC adolescents. PARTICIPANTS AND SETTING Adolescents between 12 and 18 years seen in a tertiary pediatric health care system in a Midwestern city with a metropolitan population of >2 million. METHODS This was a 46-month retrospective case-control study. Cases included adolescents who screened high risk or positive for CSEC. Control group 1 included adolescents who screened negative for CSEC. Control group 2 were adolescents who were not screened for CSEC, matched to cases and to control group 1. The three study groups were compared for frequency of, location of, and diagnosis given for medical visits. RESULTS There were 119 CSEC adolescents, 310 CSEC negative, and 429 unscreened adolescents. Compared to the controls, CSEC positive adolescents sought care less frequently (p < 0.001) and were more likely to present to an acute care setting (p < 0.0001). CSEC cases sought medical care in the acute setting more commonly for inflicted injuries (p < 0.001), mental health (p < 0.001), and reproductive health (p = 0.003). In primary care, CSEC adolescents were more commonly seen for reproductive health (p = 0.002) and mental health (p = 0.006). CONCLUSIONS CSEC adolescents differ from non-CSEC adolescents in frequency, location, and reasons for seeking healthcare.
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Affiliation(s)
- Cree Kachelski
- Division of Child Adversity and Resilience, Children's Mercy Kansas City, 2401 Gillham Rd, Kansas City, MO 64108, United States of America; Division of Emergency Medicine, Children's Mercy Kansas City, 2401 Gillham Rd, Kansas City, MO 64108, United States of America.
| | - Jennifer Hansen
- Division of Child Adversity and Resilience, Children's Mercy Kansas City, 2401 Gillham Rd, Kansas City, MO 64108, United States of America
| | - Mary E Moffatt
- Division of Child Adversity and Resilience, Children's Mercy Kansas City, 2401 Gillham Rd, Kansas City, MO 64108, United States of America; Division of Emergency Medicine, Children's Mercy Kansas City, 2401 Gillham Rd, Kansas City, MO 64108, United States of America
| | - Grace Arends
- Division of Emergency Medicine, Children's Mercy Kansas City, 2401 Gillham Rd, Kansas City, MO 64108, United States of America
| | - Ashley Sherman
- Department of Health Services and Outcomes Research, Children's Mercy Kansas City, 2401 Gillham Rd, Kansas City, MO 64108, United States of America
| | - Jim Anderst
- Division of Child Adversity and Resilience, Children's Mercy Kansas City, 2401 Gillham Rd, Kansas City, MO 64108, United States of America
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Gerassi LB, Cruys C, Hendry N, Del Carmen Rosales M. How Do Providers Assess Young People for Risk of Sex Trafficking? Observed Indicators, Follow-Up, and Assessment Questions from a Sample of Social Service Providers. CHILDREN AND YOUTH SERVICES REVIEW 2023; 148:106906. [PMID: 37065722 PMCID: PMC10104439 DOI: 10.1016/j.childyouth.2023.106906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
The extent to which service providers across systems identify and assess potentially sex trafficked youth is understudied. The purpose of this study is to determine whether and how providers observe relevant indicators and assess for sex trafficking risk among minors (ages 12-17), young adults (ages 18-29), and families of minors. A cross-sectional, web-based survey was disseminated to service providers, who represented child welfare, youth justice, and social services (e.g. runaway youth, sexual violence), in a region of a Midwestern state (United States). Participants (N=267) were asked whether they provided direct services to minors (ages 12-17, n=245), adults (ages 18-29, n=148), and/or families/foster families of minors (ages 12-17, n=163), resulting in three respective client groups. Survey items assessed the extent to which providers (1) identified possible sex trafficking indicators across 5 domains; (2) took follow up actions; and (3) asked risk assessment questions. T-tests were conducted to examine differences between those who reported receiving sex trafficking trainings, compared to those who did not. Results suggest that the most commonly identified indicators included depressive symptoms, shame and guilt, lack of social support. Least common indicators included torture, false IDs, hotel involvement. A third of minor-aged providers did not ask sex trafficking risk assessment questions. Providers reported asking fewer clients about online sex trading than in-person forms. There were statistically significant differences among providers who received training. Implications, including provider strategies for assessing online sex trading and organizational protocols to enhance sex trafficking identification, are discussed.
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Affiliation(s)
- Lara B Gerassi
- University of Wisconsin-Madison Sandra Rosenbaum School of Social Work
| | - Caro Cruys
- University of Wisconsin-Madison Sandra Rosenbaum School of Social Work
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Greenbaum J, Kaplan D, Young J, Asnes AG, Gavril AR, Gilmartin ABH, Girardet RG, Heavilin ND, Laskey A, Messner SA, Mohr BA, Nienow SM, Rosado N, Forkey H, Keefe R, Keeshin B, Matjasko J, Edward H, Stedt E, Linton J, Gutierrez R, Caballero T, Falusi O“LO, Giri M, Griffin M, Ibrahim A, Mukerjee K, Shah S, Shapiro A, Young J. Exploitation, Labor and Sex Trafficking of Children and Adolescents: Health Care Needs of Patients. Pediatrics 2023; 151:190310. [PMID: 36827522 DOI: 10.1542/peds.2022-060416] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2022] [Indexed: 12/23/2022] Open
Abstract
Exploitation and labor and sex trafficking of children and adolescents is a major public health problem in the United States and throughout the world. Significant numbers of US and non-US-born children and adolescents (including unaccompanied immigrant minors) are affected by this growing concern and may experience a range of serious physical and mental health problems associated with human trafficking and exploitation (T/E). Despite these considerations, there is limited information available for health care providers regarding the nature and scope of T/E and how providers may help recognize and protect children and adolescents. Knowledge of risk factors, recruitment practices, possible indicators of T/E, and common medical, mental, and emotional health problems experienced by affected individuals will assist health care providers in recognizing vulnerable children and adolescents and responding appropriately. A trauma-informed, rights-based, culturally sensitive approach helps providers identify and treat patients who have experienced or are at risk for T/E. As health care providers, educators, and leaders in child advocacy and development, pediatricians play an important role in addressing the public health issues faced by children and adolescents who experience exploitation and trafficking. Working across disciplines with professionals in the community, health care providers can offer evidence-based medical screening, treatment, and holistic services to individuals who have experienced T/E and assist vulnerable patients and families in recognizing signs of T/E.
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Affiliation(s)
- Jordan Greenbaum
- International Centre for Missing and Exploited Children, Alexandria, Virginia
| | - Dana Kaplan
- Department of Pediatrics, Staten Island University Hospital, Northwell Health Physician Partners, Staten Island, New York.,The Barbara and Donald Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Janine Young
- Department of Pediatrics, University of California, San Diego, California
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Furbacher J, Fockele C, Del Buono B, Janneck L, March C, Molina M, Duber H, Doran K, Lin M, Cooper R, Modi P. 2021 SAEM Consensus Conference Proceedings: Research Priorities for Developing Emergency Department Screening Tools for Social Risks and Needs. West J Emerg Med 2022; 23:817-822. [DOI: 10.5811/westjem.2022.8.57271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/17/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction: The Emergency Department (ED) acts as a safety net for our healthcare system. While studies have shown increased prevalence of social risks and needs among ED patients, there are many outstanding questions about the validity and use of social risks and needs screening tools in the ED setting.
Methods: In this paper, we present research gaps and priorities pertaining to social risks and needs screening tools used in the ED, identified through a consensus approach informed by literature review and external expert feedback as part of the 2021 SAEM Consensus Conference -- From Bedside to Policy: Advancing Social Emergency Medicine and Population Health.
Results: Four overarching research gaps were identified: (1) Defining the purpose and ethical implications of ED-based screening; (2) Identifying domains of social risks and needs; (3) Developing and validating screening tools; and (4) Defining the patient population and type of screening performed. Furthermore, the following research questions were determined to be of highest priority: (1) What screening tools should be used to identify social risks and needs? (2) Should individual EDs use a national standard screening tools or customized screening tools? (3) What are the most prevalent social risks and needs in the ED? and (4) Which social risks and needs are most amenable to intervention in the ED setting?
Conclusion: Answering these research questions will facilitate the use of evidence-based social risks and needs screening tools that address knowledge gaps and improve the health of our communities by better understanding the underlying determinants contributing to their presentation and health outcomes.
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Affiliation(s)
- Jacqueline Furbacher
- University of Massachusetts Chan Medical School, Department of Emergency Medicine, Worcester, Massachusetts
| | - Callan Fockele
- University of Washington, Department of Emergency Medicine, Seattle, Washington
| | - Ben Del Buono
- Virginia Commonwealth University, Department of Emergency Medicine, Richmond, Virginia
| | - Laura Janneck
- University of Oklahoma School of Community Medicine, Department of Emergency Medicine, Tulsa, Oklahoma
| | - Cooper March
- University of Washington, Department of Emergency Medicine, Seattle, Washington
| | - Melanie Molina
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California
| | - Herbet Duber
- University of Washington, Department of Emergency Medicine, Seattle, Washington
| | - Kelly Doran
- NYU School of Medicine, Departments of Emergency Medicine and Population Health, New York, New York
| | - Michelle Lin
- Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California
| | - Richelle Cooper
- UCLA School of Medicine, Department of Emergency Medicine, Los Angeles, California
| | - Payal Modi
- University of Massachusetts Chan Medical School, Department of Emergency Medicine, Worcester, Massachusetts
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Current Practices and Nurse Readiness to Implement Standardized Screening for Commercially and Sexually Exploited Individuals in Emergency Departments in Western Washington Hospitals. Adv Emerg Nurs J 2022; 44:322-332. [DOI: 10.1097/tme.0000000000000427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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14
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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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Hainaut M, Thompson KJ, Ha CJ, Herzog HL, Roberts T, Ades V. Are Screening Tools for Identifying Human Trafficking Victims in Health Care Settings Validated? A Scoping Review. Public Health Rep 2022; 137:63S-72S. [PMID: 35775913 DOI: 10.1177/00333549211061774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Although many screening tools, resources, and programs for identifying victims of human trafficking exist, consensus is lacking on which tools are most useful, which have been validated, and whether they are effective. The objectives of this study were to determine what tools exist to identify or screen for victims of human trafficking in health care settings and whether these tools have been validated. METHOD We conducted a scoping review of the literature on human trafficking identification in health care settings following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) protocol for scoping reviews. We searched the MEDLINE, PsycInfo, Embase, and Scopus databases without language or date limitations. Two independent reviewers screened each citation. We included human research studies in English with populations of all ages, all genders, all geographic locations, and using quantitative and/or qualitative research methods. We excluded studies that were not conducted in a health care setting, review articles, and meta-analyses. We summarized additional screening tools available online and identified through hand-searching. RESULTS Database searches yielded 8730 studies, of which 4806 remained after removing duplicates. We excluded 4720 articles based on title/abstract review, we reviewed 85 full-text studies for eligibility, and we included 8 articles. Hand-searching revealed 9 additional screening tools not found in the literature. Through our search for validated screening tools, only 6 had been studied for validation in health care settings. CONCLUSIONS Few studies have evaluated screening tools for identifying victims of human trafficking in health care settings. The absence of a gold standard for human trafficking screening and lack of consensus on the definition of human trafficking make screening tool validation difficult. Further research is required for the development of safe, effective approaches to patient screening.
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Affiliation(s)
| | | | - Caryn J Ha
- Graduate School of Arts and Science, Georgetown University, Washington, DC, USA
| | - Hayley L Herzog
- School of Global Public Health, New York University, New York, NY, USA.,Wagner Graduate School of Public Service, New York University, New York, NY, USA
| | - Timothy Roberts
- NYU Grossman School of Medicine, Health Sciences Library, New York University, New York, NY, USA
| | - Veronica Ades
- Department of Obstetrics and Gynecology, Jacobi Medical Center, Bronx, NY, USA.,Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York University, New York, NY, USA.,Department of Obstetrics, Gynecology, and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA
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16
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Sprang G, Stoklosa H, Greenbaum J. The Public Health Response to Human Trafficking: A Look Back and a Step Forward. Public Health Rep 2022; 137:5S-9S. [PMID: 35775916 DOI: 10.1177/00333549221085588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Ginny Sprang
- Center on Trauma and Children, College of Medicine/Department of Psychiatry, University of Kentucky, Lexington, KY, USA
| | - Hanni Stoklosa
- HEAL Trafficking (Health, Education, Advocacy, Linkage), Los Angeles, CA, USA.,Department of Emergency Medicine, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jordan Greenbaum
- International Centre for Missing and Exploited Children, Alexandria, VA, USA.,Stephanie V. Blank Center for Safe and Healthy Children at Children's Healthcare of Atlanta, Alexandria, VA, USA
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17
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Ellis AS, Brown AM, Martini AI, Page E, Lin L, Vaughn LM. Application of a Child Sex Trafficking Screening Tool in Patients with Abuse: A Retrospective Chart Review in the Pediatric Emergency Department. J Pediatr Health Care 2022; 36:330-338. [PMID: 35219548 DOI: 10.1016/j.pedhc.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 01/13/2022] [Accepted: 01/16/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Human trafficking (HT) is a global problem that may affect children's health. In the United States, victims and children are at risk in most communities. History of abuse is a risk factor for HT. This study explored associations between pediatric patients with positive universal abuse screens and indicators from the commercial sexual exploitation of children/child sex trafficking (CSEC/CST) screening tool. METHOD A retrospective chart review was conducted on random patients, aged 11-17 years, with positive universal abuse screens at emergency/urgent care departments in a large Midwest pediatric medical center in 2018. Documentation identifying at least two CSEC/CST screening tool indicators was abstracted from these records. Data analysis included descriptive statistics, univariate analyses, and correlations. RESULTS Two or more indicators from the CSEC/CST screening tool were identified in 43% (n = 121). Age and history of running away were significant predictors for a patient having two or more CSEC/CST positive indicators. DISCUSSION Targeted screening and interventions are needed to identify and help these vulnerable youth.
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18
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Interiano-Shiverdecker CG, Romero DE, Anderson A, Castellon NE. A Content Analysis of Sex Trafficking Instruments. INTERNATIONAL JOURNAL FOR THE ADVANCEMENT OF COUNSELLING 2022. [DOI: 10.1007/s10447-021-09463-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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19
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Ekstrom J, Alfath Z, Schneider K. Sexual History Documentation and Sexually Transmitted Infection Screening for Mental Health Patients in a Pediatric Emergency Department. Pediatr Emerg Care 2022; 38:9-12. [PMID: 34986577 DOI: 10.1097/pec.0000000000002593] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Adolescents with psychiatric conditions more commonly engage in high-risk sexual behaviors and are at increased risk of sexually transmitted infections (STIs) and when presenting to pediatric emergency departments (PEDs) may be an important population in which to target screening efforts. This study aimed to determine frequency of physician-documented sexual history and STI screening in adolescents presenting to a PED with mental health-related complaints. METHODS Retrospective study of patients aged 14 to 18 years presenting to a PED February 2015 to September 2016. Electronic records were reviewed for demographics, chief complaint, sexual history documentation, STI screening, resident involvement in patient care, and disposition. Proportions were calculated for frequencies, whereas χ2 and Fisher exact tests evaluated factors associated with documentation of sexual history and STI screening. RESULTS Two hundred eighty-five patient encounters were identified. Age range was 15 to 18 years with an average of 16 years, and 58% were girls. The most common chief complaint was "intentional ingestion/overdose" (169 encounters, 59%) followed by "suicidal/attempted suicide" (59, 21%). Seventy-seven patients (27%) had sexual history documented. Girls were more likely to have sexual history documented (75% vs 52%, P = 0.0004). Forty-five (59%) patients were noted to be sexually active, and 17 (38%) of these were screened for STI. There was no relationship between screening and race, sex, or involvement of a resident in patient care. CONCLUSIONS In a high-risk PED population, physicians documented sexual history only 27% of the time. Female patients were more likely to have a sexual history documented. In patients with sexual history indicating risk for STI, less than half were screened.
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Affiliation(s)
- Joanna Ekstrom
- From the Department of Pediatrics, Division of Pediatric Emergency Medicine, Children's Minnesota
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20
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Greenbaum J. Child Labor and Sex Trafficking. Pediatr Rev 2021; 42:639-654. [PMID: 34850175 DOI: 10.1542/pir.2020-001396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Regardless of their practice setting or subspecialty, pediatricians are likely to encounter children who have experienced sex or labor trafficking or who are at risk for exploitation. Only 24.1% of health professionals in one study reported receiving previous training on human trafficking; after a brief presentation on the topic, 39.6% indicated that they knew or suspected they had cared for a trafficked person in the past 3 months. Trafficked and exploited children can present with myriad physical or mental health conditions; most have experienced repeated, significant trauma; and few are likely to spontaneously disclose their exploitative situation. As a result, clinicians face challenges in recognizing and appropriately responding to potential human trafficking. Knowledge of common risk factors and potential indicators of exploitation can assist the pediatrician in recognizing affected and at-risk youth. However, health professionals report that existing training tends to focus on general information about trafficking, with relatively little time spent discussing the specifics of the trauma-informed approach to patient interactions. Given the critical importance of building patient trust, empowering patients to share their concerns, and engaging them in their own care and safety planning, this article focuses on the practical aspects of working with trafficked and exploited children. A brief overview of human trafficking is followed by an extensive discussion of rights-based, culturally sensitive, trauma-informed strategies for interacting with vulnerable patients.
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Affiliation(s)
- Jordan Greenbaum
- International Centre for Missing and Exploited Children, Alexandria, VA.,Institute on Healthcare and Human Trafficking, Stephanie V. Blank Center for Safe and Healthy Children, Children's Healthcare of Atlanta, Atlanta, GA
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21
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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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22
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Carrellas A, Resko SM, Day AG. Sexual victimization and intellectual disabilities among child welfare involved youth. CHILD ABUSE & NEGLECT 2021; 115:104986. [PMID: 33640733 DOI: 10.1016/j.chiabu.2021.104986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/30/2020] [Accepted: 01/28/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Youth with intellectual disabilities involved in child welfare systems are at greater risk of sexual victimization than youth who have not been investigated for child maltreatment. This study addresses a gap in the literature regarding older youth with intellectual disabilities who are sexually victimized and pushed to engage in transactional sex while they are transitioning from child welfare systems involvement. It does so by examining risk and protective factors at the individual, micro, exo, and macro systems levels. PARTICIPANTS AND SETTING This study included 334 youth ages 18-19.5 from a nationally representative sample of 5,872 child welfare-involved youth. METHODS Multivariate logistic regression models were used to conduct a secondary analysis of the National Survey of Child and Adolescent Well-Being II to examine relationships between intellectual ability, social support, and community environment and sexual victimization and engaging in transactional sex. RESULTS Results indicate that 2.5 % of the youth experienced sexual victimization in the past 12 months, and 3.9 % had engaged in transactional sex in the past 6 months. The mean intelligence score for these youth was one standard deviation below average (M = 84.62, SD = 19.60). Being female was associated with experiencing sexual victimization (Odds Ratio = 17.29, p = .025). Higher intellectual ability scores were associated with lower odds of engaging in paid sexual activity (Odds Ratio = 0.92, p = .002). CONCLUSIONS This study highlights the need for early identification of intellectual disabilities among child welfare-involved youth, provision of informed social supports and services, and building community connections during transition to prevent sexual victimization.
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Affiliation(s)
- Ann Carrellas
- University of Toledo, College of Health and Human Services, School of Social Justice, 2801 West Bancroft Street, Toledo, OH, 43606, USA.
| | - Stella M Resko
- Wayne State University, School of Social Work, 5447 Woodward Avenue, Detroit, MI, 48202, USA.
| | - Angelique G Day
- University of Washington, School of Social Work, 4101 15th Ave. NE, Seattle, WA, 98105, USA.
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23
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Abstract
Human trafficking and child sex trafficking and sexual exploitation in particular are global public health issues with widespread, lasting impacts on children, families, and communities. Traditionally, human trafficking has been treated as a law enforcement problem with an emphasis on the arrest and prosecution of traffickers. However, use of a public health approach focuses efforts on those impacted by exploitation: trafficked persons, their families, and the population at large. It promotes strategies to build a solid scientific evidence base that allows development, implementation, and evaluation of prevention and intervention efforts, informs policy and program development, and guides international efforts at eradication. This article uses the public health approach to address human trafficking, with a focus on child sex trafficking and exploitation. Recommendations are made for public health professionals to contribute to antitrafficking efforts globally.
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Affiliation(s)
- Jordan Greenbaum
- International Centre for Missing and Exploited Children, Alexandria, Virginia 22314, USA; .,Stephanie V. Blank Center for Safe and Healthy Children, Children's Healthcare of Atlanta, Atlanta, Georgia 30342, USA
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24
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Abstract
Sexual violence against children is a gross violation of children's rights during their formative years and will likely interfere with their developmental trajectory and long-term quality of life. As a result, this form of violence includes commercial sexual exploitation of children, sexual abuse, child marriages, and female genital mutilation. The evidence shows that violence prevention is worth the investment; however, prioritizing this agenda to ensure funding through government spending remains low. Despite funding realities, research and advocacy efforts need to continue, with a focus on promoting effective practices for mitigation.
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Affiliation(s)
- Ingrid Walker-Descartes
- Department of Medical Education-Pediatrics, Maimonides Children's Hospital of Brooklyn, 4802 Tenth Avenue, Brooklyn, NY 11219, USA.
| | - Gillian Hopgood
- Department of Medical Education-Pediatrics, Maimonides Children's Hospital of Brooklyn, 4802 Tenth Avenue, Brooklyn, NY 11219, USA
| | - Luisa Vaca Condado
- Department of Medical Education-Pediatrics, Maimonides Children's Hospital of Brooklyn, 4802 Tenth Avenue, Brooklyn, NY 11219, USA
| | - Lori Legano
- Department of Pediatrics, Bellevue Hospital Center, 462 First Avenue, New York, NY 10016, USA
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25
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Hurst IA, Abdoo DC, Harpin S, Leonard J, Adelgais K. Confidential Screening for Sex Trafficking Among Minors in a Pediatric Emergency Department. Pediatrics 2021; 147:e2020013235. [PMID: 33593847 PMCID: PMC7924137 DOI: 10.1542/peds.2020-013235] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Child sex trafficking is a global health problem, with a prevalence of 4% to 11% among high-risk adolescents. The objective of this study was to confidentially administer a validated screening tool in a pediatric emergency department by using an electronic tablet to identify minors at risk for sex trafficking. Our hypothesis was that this modality of administration would adequately identify high-risk patients. METHODS English- and Spanish-speaking patients from the ages of 12 to 17 years presenting to a large urban pediatric emergency department with high-risk chief complaints were enrolled in a prospective cohort over 13 months. Subjects completed a previously validated 6-item screening tool on an electronic tablet. The screening tool's sensitivity, specificity, and positive and negative predictive values were calculated. Multivariable logistic regression was performed to identify additional risk factors. RESULTS A total of 212 subjects were enrolled (72.6% female; median age: 15 years; interquartile range 13-16), of which 26 patients were subjected to child sex trafficking (prevalence: 12.3%). The sensitivity and specificity of the electronic screening tool were 84.6% (95% confidence interval [CI] 70.8%-98.5%) and 53.2% (95% CI 46.1%-60.4%), respectively. The positive predictive value and negative predictive value were 20.2% (95% CI 12.7%-27.7%) and 96.1% (95% CI 92.4%-99.9%), respectively. A previous suicide attempt and history of child abuse increased the odds of trafficking independent of those who screened positive but did not improve sensitivity of the tool. CONCLUSIONS A confidentially administered, previously validated, electronic screening tool was used to accurately identify sex trafficking among minors, suggesting that this modality of screening may be useful in busy clinical environments.
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Affiliation(s)
- Irene A Hurst
- Section of Pediatric Emergency Medicine and
- Children's Hospital Colorado, Aurora, Colorado
| | - Denise C Abdoo
- Section of Pediatric Emergency Medicine and
- Children's Hospital Colorado, Aurora, Colorado
- Kempe Center, Department of Pediatrics, School of Medicine and
| | - Scott Harpin
- Children's Hospital Colorado, Aurora, Colorado
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado; and
| | - Jan Leonard
- Section of Pediatric Emergency Medicine and
- Children's Hospital Colorado, Aurora, Colorado
| | - Kathleen Adelgais
- Section of Pediatric Emergency Medicine and
- Children's Hospital Colorado, Aurora, Colorado
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26
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Wallace C, Schein Y, Carabelli G, Patel H, Mehta N, Dowshen N, Kassam-Adams N, Ginsburg K, Mollen C. A Survivor-Derived Approach to Addressing Trafficking in the Pediatric ED. Pediatrics 2021; 147:peds.2020-0772. [PMID: 33334922 DOI: 10.1542/peds.2020-0772] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Our objective was to elicit the perspectives of survivors of child trafficking on addressing trafficking in the pediatric emergency department (ED) and, secondarily, to provide a survivor-derived framework to help pediatric emergency medicine (PEM) providers discuss trafficking with their patients. METHODS We conducted in-depth, semistructured interviews with young adults who experienced trafficking as children and/or as adolescents. In the interviews, we employed a novel video-elicitation method designed by the research team to elicit detailed participant feedback and recommendations on the pediatric ED through an interactive, immersive discussion with the interviewer. A grounded theory approach was employed. RESULTS Seventeen interviews were conducted revealing the following themes, which we present in an integrated framework for PEM providers: (1) fear is a significant barrier; (2) participants do want PEM providers to ask about trafficking, and it is not harmful to do so; (3) PEM providers should address fear through emphasizing confidentiality and privacy and encouraging agency; (4) PEM providers should approach the patient in a direct, sensitive, and nonjudgmental manner; and (5) changes to the ED environment may facilitate the conversation. Suggested wordings and tips from survivors were compiled. CONCLUSIONS Trafficking survivors feel that the pediatric ED can be a place where they can be asked about trafficking, and that when done in private, it is not harmful or retraumatizing. Fear is a major barrier to disclosure in the pediatric ED setting, and PEM providers can mitigate this by emphasizing privacy and confidentiality and increasing agency by providing choices. PEM providers should be direct, sensitive, and nonjudgmental in their approach to discussing trafficking.
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Affiliation(s)
- Carmelle Wallace
- Division of Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama;
| | - Yvette Schein
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | | | | | - Needhi Mehta
- Division of Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Nadia Dowshen
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and.,Divisions of Adolescent Medicine and
| | - Nancy Kassam-Adams
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and.,Center for Injury Research and Prevention and
| | - Kenneth Ginsburg
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and.,Divisions of Adolescent Medicine and
| | - Cynthia Mollen
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and.,Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Coughlin CG, Greenbaum J, Titchen K. Educating paediatric health-care providers about human trafficking. J Paediatr Child Health 2020; 56:1335-1339. [PMID: 32815607 DOI: 10.1111/jpc.15116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/02/2020] [Accepted: 07/17/2020] [Indexed: 11/26/2022]
Abstract
Human trafficking is a public health issue and humanitarian crisis. Most alarming is that children are especially at risk. Although many studies demonstrate that the majority of trafficked persons surveyed engage with the health-care system during the time in which they are trafficked, health-care practitioners lack the knowledge, tools and resources to assist these patients. The present efforts in training health-care professionals have been fragmented and largely ineffective. While prior training has produced short-term changes in knowledge or attitudes of health professionals, it has not produced sustained changes in knowledge and attitudes nor meaningful changes in screening or intervention. No training has demonstrated changes in patient outcomes. Trafficked persons, particularly children and survivors of labour trafficking, are inadequately served by our present training options for health-care practitioners, and evidence-based protocols are needed to care for this underserved, disenfranchised and traumatised population. To provide optimal care for trafficked youth, health-care practitioners may benefit from: (i) evaluating training for health care providers (HCP) rigorously and meaningfully; (ii) advocating for high-quality training for all HCPs; (iii) fostering partnerships with key stakeholders to inform training and practice; and (iv) designing HCP training that is comprehensive, spanning all forms of human trafficking and including all populations involved.
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Affiliation(s)
- Catherine G Coughlin
- Department of Medicine, Boston Children's Hospital, Boston, Massachusetts, United States.,Department of Pediatrics, Boston Medical Center, Boston, Massachusetts, United States
| | - Jordan Greenbaum
- Department of Pediatrics Emory School of Medicine, Global Child Health and Well Being Initiative, International Center for Missing and Exploited Children, Alexandria, Virginia, United States.,Stephanie V. Blank Center for Safe and Healthy Children, Children's Healthcare of Atlanta, Atlanta, Georgia, United States
| | - Kanani Titchen
- San Diego School of Medicine, Division of General Academic Pediatrics, Developmental Pediatrics, and Center for Community Health, University of California, La Jolla, California, United States
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28
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Laird JJ, Klettke B, Hall K, Clancy E, Hallford D. Demographic and Psychosocial Factors Associated With Child Sexual Exploitation: A Systematic Review and Meta-analysis. JAMA Netw Open 2020; 3:e2017682. [PMID: 32960280 PMCID: PMC7509625 DOI: 10.1001/jamanetworkopen.2020.17682] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE Although research has examined factors associated with child sexual exploitation (CSE), consensus is lacking in regard to which factors should be prioritized, thereby hindering policy reform, prevention efforts, and development of early detection and intervention. OBJECTIVE To provide a meta-analytic synthesis of studies examining factors associated with CSE and to quantify their relative importance. DATA SOURCES Electronic databases searched to June 2019 included Medline, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature, EMBASE, and Informit, yielding 396 nonduplicative records. Literature search was performed in July 2019. STUDY SELECTION Inclusion criteria were quantitative investigations of sexual exploitation and mean sample age of 18 years or younger. DATA EXTRACTION AND SYNTHESIS Literature review and data extraction followed Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Thirty-seven studies met final inclusion criteria. Two independent reviewers extracted all relevant data. Random-effects meta-analyses were used to derive odds ratios (ORs) for each factor. Data were analyzed from September 1 to October 28, 2019, and prediction intervals calculated in June 2020. MAIN OUTCOMES AND MEASURES Child sexual exploitation, defined as coerced sexual acts between a child or a young person (aged ≤18 years) and an individual or a group in exchange for money, gifts, substances, or other commodities and associated factors. RESULTS Thirty-seven unique studies were included with a total of 67 453 unique participants (mean [SD] age of 16.2 [2.5] years; 49.9% female). Fifty-two factors associated with CSE were included in the meta-analysis. The strongest factors significantly associated with exposure to sexual exploitation were engagement in sexual risk behaviors (OR, 6.31 [95% CI, 3.12-12.76]; P < .001), having more than 5 sexual partners (OR, 5.96 [95% CI, 1.63-21.87]; P = .007), a diagnosis of posttraumatic stress disorder (OR, 5.29 [95% CI, 3.40-8.22]; P < .001), historical exposure to child pornography (OR, 5.50 [95% CI, 0.99-30.53]; P = .049), and a history of childhood sexual abuse (OR, 3.80 [95% CI, 3.19-4.52]; P < .001). A number of other potentially modifiable factors had moderate to strong associations. CONCLUSIONS AND RELEVANCE In this systematic review and meta-analysis, children and adolescents affected by sexual exploitation showed high levels of sexual risk taking, multiple sexual partners, posttraumatic stress disorder, exposure to child pornography, and childhood trauma. Accurate detection of CSE may prevent this type of sexual violence occurring to adolescents and/or provide opportunities for intervention and recovery. Therefore, prevention and intervention efforts will likely benefit from integrating these factors into screening, assessment, and treatment.
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Affiliation(s)
- Jessica J. Laird
- School of Psychology, Faculty of Health, Deakin University, Burwood, Australia
| | - Bianca Klettke
- School of Psychology, Faculty of Health, Deakin University, Burwood, Australia
- Center for Social and Early Emotional Development, Deakin University, Burwood, Australia
| | - Kate Hall
- School of Psychology, Faculty of Health, Deakin University, Burwood, Australia
- Addictive and Anti-Social Behaviour Research, Deakin University Centre for Drug Use, Geelong, Australia
| | - Elizabeth Clancy
- School of Psychology, Faculty of Health, Deakin University, Burwood, Australia
- Center for Social and Early Emotional Development, Deakin University, Burwood, Australia
| | - David Hallford
- School of Psychology, Faculty of Health, Deakin University, Burwood, Australia
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29
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Thomas-Smith S, Homer P, Thomas AA. Advocacy & Pediatric Human Trafficking. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2020. [DOI: 10.1016/j.cpem.2020.100774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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30
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Hornor G, Sherfield J, Tscholl J. Teen Knowledge of Commercial Sexual Exploitation of Children. J Pediatr Health Care 2020; 34:239-245. [PMID: 31955901 DOI: 10.1016/j.pedhc.2019.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/09/2019] [Accepted: 11/11/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The commercial sexual exploitation of children (CSEC) is a pediatric health care problem with significant physical and mental health consequences for victims, even death. Although there exists community-wide collaborations in the United States to address professional response to CSEC, these efforts often have a limited capacity to reach adolescents and involve them in CSEC prevention. As part of a prevention strategy, the National Institute of Justice recommends educating youth about CSEC and exploiters' recruitment tactics. Despite this recommendation, little is known regarding American youth knowledge of CSEC. METHODS A descriptive research design was used for this study. All adolescents, male and female, presenting to a high-volume urban pediatric hospital-based Midwestern Child Advocacy Center (CAC) due to concerns for alleged sexual abuse were invited to participate in the study by answering a self- administered electronic questionnaire. This questionnaire explores the participants' knowledge, awareness, and attitudes about CSEC, in addition to collecting demographic data, such as participant age, gender identity, grade, school district, and school. RESULTS During the six-month study period, 286 CAC patients were eligible to participate in the study. Nearly all participants (n = 217; 97%) agreed that pimping is wrong. While the majority of participants indicated an awareness of human trafficking (n = 198; 94%) and sex trafficking (n = 193; 87%); just (n = 91; 41%) had heard of labor trafficking. Fewer participants (n = 55; 25%) identified that a doctor, nurse, or other health care provider had ever spoken with them about sex trafficking. DISCUSSION Study participants overwhelmingly conveyed negative attitudes toward CSEC. Participating adolescents indicated a significantly higher awareness of sex trafficking (87%) versus labor trafficking (10%). Sex trafficking receives more attention in the media than labor trafficking. Given that study participants indicated hearing about trafficking primarily from the media (74%) and family/friends, this may explain the deficit in labor trafficking awareness. Although study participants demonstrated mostly accurate baseline knowledge of CSEC, that knowledge was not universal.
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Leopardi NM, Hovde AM, Kullmann LV. The Intersection of Child Trafficking and Health Care: Our Unique Role as Pediatric Clinicians. Pediatr Clin North Am 2020; 67:413-423. [PMID: 32122569 DOI: 10.1016/j.pcl.2019.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Human trafficking is a pervasive public health problem that affects children of all ages. Health care clinicians can play a unique role in identifying and intervening for trafficking victims through acknowledging biases, understanding the risk factors and red flags, and implementing a trauma-informed care approach in their clinics and institutions. It is through collaboration, education, and research that health care clinicians can work to recognize and respond to this crime perpetrated against the youngest and most vulnerable patients.
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Affiliation(s)
- Nicole M Leopardi
- Pediatrics Clerkship, Medical Home for Trafficked Minors, Cooper University Healthcare, Children's Regional Center, CMSRU, 3 Cooper Plaza, Suite 200, Camden, NJ 08103, USA
| | - Aldina M Hovde
- Safety and Trauma Informed Care Initiatives, New Jersey Chapter, American Academy of Pediatrics, 50 Millstone Road, Building 200, Suite 130, East Windsor, NJ 08520, USA.
| | - Lauren V Kullmann
- Rowan University, School of Osteopathic Medicine, 1 Medical Center Drive, Stratford, NJ 08084, USA
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McTavish JR, Gonzalez A, Santesso N, MacGregor JCD, McKee C, MacMillan HL. Identifying children exposed to maltreatment: a systematic review update. BMC Pediatr 2020; 20:113. [PMID: 32145740 PMCID: PMC7060650 DOI: 10.1186/s12887-020-2015-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 02/28/2020] [Indexed: 11/10/2022] Open
Abstract
Background Child maltreatment affects a significant number of children globally. Strategies have been developed to identify children suspected of having been exposed to maltreatment with the aim of reducing further maltreatment and impairment. This systematic review evaluates the accuracy of strategies for identifying children exposed to maltreatment. Methods We conducted a systematic search of seven databases: Medline, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Cochrane Libraries, Sociological Abstracts and the Education Resources Information Center. We included studies published from 1961 to July 2, 2019 estimating the accuracy of instruments for identifying potential maltreatment of children, including neglect, physical abuse, emotional abuse, and sexual abuse. We extracted data about accuracy and narratively synthesised the evidence. For five studies—where the population and setting matched known prevalence estimates in an emergency department setting—we calculated false positives and negatives. We assessed risk of bias using QUADAS-2. Results We included 32 articles (representing 31 studies) that evaluated various identification strategies, including three screening tools (SPUTOVAMO checklist, Escape instrument, and a 6-item screening questionnaire for child sex trafficking). No studies evaluated the effects of identification strategies on important outcomes for children. All studies were rated as having serious risk of bias (often because of verification bias). The findings suggest that use of the SPUTOVAMO and Escape screening tools at the population level (per 100,000) would result in hundreds of children being missed and thousands of children being over identified. Conclusions There is low to very low certainty evidence that the use of screening tools may result in high numbers of children being falsely suspected or missed. These harms may outweigh the potential benefits of using such tools in practice (PROSPERO 2016:CRD42016039659).
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Affiliation(s)
- Jill R McTavish
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, 1280 Main Street West, MIP 201A, Hamilton, ON, L8S 4K1, Canada.
| | - Andrea Gonzalez
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, 1280 Main Street West, MIP 201A, Hamilton, ON, L8S 4K1, Canada
| | - Nancy Santesso
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, 2C Area, Hamilton, ON, L8S 4K1, Canada
| | - Jennifer C D MacGregor
- Faculty of Information & Media Studies, Western University, FIMS & Nursing Building, Room 2050, London, ON, N6A 5B9, Canada
| | - Chris McKee
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, 1280 Main Street West, MIP 201A, Hamilton, ON, L8S 4K1, Canada
| | - Harriet L MacMillan
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, 1280 Main Street West, MIP 201A, Hamilton, ON, L8S 4K1, Canada.,Department of Pediatrics, McMaster University, 1280 Main Street West, MIP 201A, Hamilton, ON, L8S 4K1, Canada
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Peck JL. Human Trafficking of Children: Nurse Practitioner Knowledge, Beliefs, and Experience Supporting the Development of a Practice Guideline: Part Two. J Pediatr Health Care 2020; 34:177-190. [PMID: 31866214 DOI: 10.1016/j.pedhc.2019.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/30/2019] [Accepted: 11/11/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Part 1 of this series addressed low levels of awareness about child trafficking among pediatric health care providers, supporting the need for clinical practice guidelines to aid evidence-based response to potential victims in the clinical setting. The purpose of this article was to explore evidence related to effective clinical response when encountering at-risk children or those who have experienced trafficking and make recommendations for a practice guideline. METHOD An integrated review of the literature included electronic data search of PubMed, Ovid, and CINAHL and application of the social ecological model for thematic analysis. RESULTS Research is primarily inconclusive on the effective clinical response for victims and potential victims of child trafficking, indicating the need for practice guidelines directed at both prevention and intervention. DISCUSSION This review supports pediatric clinicians as ideally equipped and situated to intervene in a myriad of care settings on behalf of children with health disparities who are vulnerable to trafficking, advocating for prevention, and optimization of equitable health outcomes.
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Murray A, Smith L. Implementing Evidence-Based Care for Women Who Have Experienced Human Trafficking. Nurs Womens Health 2019; 23:98-104. [PMID: 30853510 DOI: 10.1016/j.nwh.2019.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 12/19/2018] [Accepted: 01/01/2019] [Indexed: 10/27/2022]
Abstract
Human trafficking is a significant women's health issue in the United States. Clinicians who provide care to women are often unaware of the signs and symptoms of human trafficking and are unprepared to provide appropriate care. Nurses represent one of the few agents of change who women may encounter while they are in captivity; this places nurses at the forefront of their care. To provide safe and effective care, nurses can use the ABCD treatment model, which stands for assessment, buy-in, case management, and diversion programming. Any gaps between recognition of women's health care needs and the provision of appropriate care must be closed. Integrating evidence-based human trafficking education and skill building into nursing curricula, standard nursing orientation, and continuing education is an essential step to help nurses transform care and advocate on behalf of those who have been trafficked.
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Hammarström S, Nilsen P, Lindroth M, Stenqvist K, Bernhardsson S. Identifying young people exposed to or at risk of sexual ill health: pilot implementation of an evidence-informed toolkit (SEXIT) at Swedish youth clinics. EUR J CONTRACEP REPR 2019; 24:45-53. [DOI: 10.1080/13625187.2018.1564815] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Sofia Hammarström
- Department of Medical and Health Science, Division of Community Medicine, Linköping University, Linköping, Sweden
- Närhälsan Knowledge Center for Sexual Health, Gothenburg, Sweden
| | - Per Nilsen
- Department of Medical and Health Science, Division of Community Medicine, Linköping University, Linköping, Sweden
| | - Malin Lindroth
- Department of Nursing Sciences, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Faculty of Health and Society, Centre for Sexology and Sexuality Studies, Malmö University, Malmö, Sweden
| | - Karin Stenqvist
- Närhälsan Knowledge Center for Sexual Health, Gothenburg, Sweden
- Department of Public Health and Community Medicine, Section for Epidemiology and Social Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Susanne Bernhardsson
- Närhälsan Research and Development Primary Health Care, Gothenburg, Sweden
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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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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