Human Trafficking of Children: Nurse Practitioner Knowledge, Beliefs, and Experience Supporting the Development of a Practice Guideline: Part One

Prevention and Intervention Strategies for the Sexual Abuse and Commercial Sexual Exploitation of Children Who Run Away from Foster Care: A Scoping Review

Literature on human trafficking suggests the vulnerability to commercial sexual exploitation of children (CSEC) and child sexual abuse (CSA) changes by the prevalence of certain risk factors (e.g., runaway), trafficker-used lures (e.g., isolation), and the environmental conditions present at the time of victimization (e.g., foster care). Often, youth in foster care are at high risk for CSEC and CSA victimization associated with runaway instances. This scoping review aims to identify prevention and intervention strategies for CSEC/CSA of youth who run away from foster care. PRISMA scoping review guidelines were followed to review the literature across two search parameters (CSEC; CSA). An electronic review was conducted between August 2022 and January 2023 across four databases: PubMed, SAGE Journals Online, ScienceDirect, and Web of Science. The CSEC and CSA search parameters comprised three domains (sexual exploitation, foster care, and runaway; sexual abuse, foster care, and runaway, respectively). Literature published between 2012 and 2022 was included regardless of the methodological approach. Literature not concerning youth who run from foster care was excluded. Database searches yielded 206 publications for CSEC and 351 for CSA, reduced to 185 and 212, respectively, after removing duplicates. Seventy-one articles were identified, of which, 64 articles (28 CSEC, 36 CSA) were categorized as prevention strategies and seven (five CSEC, two CSA) as interventions. The intersection and dual victimization of CSEC and CSA of youth who run away from foster care are discussed. This paper also discusses applied behavior analysis principles for developing function-based interventions.

Empowering School Nurses: Enhancing Child Trafficking Awareness and Preparedness in American Public Schools

Child trafficking poses a momentous public health threat to students in public schools. Although school nurses are exceptionally positioned to identify and respond to trafficking, most lack training and resources in this critical area. This project aimed to evaluate the impact of a multifaceted intervention on school nurse preparedness and practices related to child trafficking in an Oklahoma public school district. The project involved Unbound Now's nationally accredited training program for school nurses, implementation of the Fuentes et al.'s Toolkit for Building a Human Trafficking School Safety Protocol (HTSSP) funded by the U.S. Department of Health and Human Services, and facilitation of a roundtable discussion to initiate community collaboration. The results of the pretraining Fraley and Aronowitz School Nurses' Awareness and Perceptions Survey (SNAPS) illuminated variations in school nurses' knowledge and awareness of child trafficking, demonstrating the need for continued training. Post-training evaluations exhibited highly positive feedback, suggesting its effectiveness in meeting the training's objectives. Following the community stakeholder roundtable, the lead school nurse employed the HTSSP toolkit and directed efforts in successfully constructing and implementing a district-wide policy of procedures to respond to suspected cases of human trafficking. However, the project's limitations include a small sample and a single-school district focus. Despite these limitations, this project delivers valuable insights into the challenges and opportunities for enhancing school nurse preparedness in addressing trafficking. This project serves as a foundation for future initiatives to improve students' safety and wellbeing in public schools.

An examination of nurse educators' Knowledge, Attitudes, Instructional Beliefs, and Instructional Practices of human trafficking

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.

Pediatric Nurse Practitioner Knowledge of and Attitudes Toward Human Trafficking: A Psychometric Evaluation

INTRODUCTION

Human trafficking is an urgent health threat. This study sought to psychometrically validate the novel Pediatric Nurse Practitioner Knowledge and Attitudes Toward Human Trafficking scale.

METHOD

Using data from a 2018 study of pediatric-focused advanced practice registered nurses (n = 777), this secondary analysis examined dimensionality and reliability of the survey.

RESULTS

The Cronbach α for scale constructs was < 0.7 for knowledge and 0.78 for attitudes. Exploratory and confirmatory analyses identified a bifactor model for knowledge with relative fit indexes within standard cutoffs, root mean square error of approximation = 0.03, comparative fit index = 0.95, Tucker-Lewis index = 0.94, and standardized root mean square residual = 0.06. The attitudes construct indicated a 2-factor model with root mean square error of approximation = 0.04, comparative fit index = 0.99, Tucker-Lewis index = 0.98, and standardized root mean square residual = 0.06, within standard cutoffs.

DISCUSSION

The scale is a promising tool in advancing nursing response to trafficking but needs further refinement to increase utility and uptake.

Human trafficking policies of professional nursing organizations: Opportunity for innovative and influential policy voice

Human trafficking is a grievous human rights violation and rapidly emerging public health threat to which most nurses are ill-equipped to effectively respond. Curricula development within academic institutions and standard setting of organizational, education, accreditation, or licensing entities are a slow-moving and complicated process ill-equipped to adequately inform nursing practice in a timely way. Professional nursing organizations are ideally situated with knowledge, skills, and attributes to effectively contribute in a timely manner to policy creation and implementation directed toward emerging health threats. This analysis identifies only nine of 104 national nursing organizations that deliver vision, skills, position statements, practice guidelines, or other tools for members seeking evidence-based, credible, professional resources to initiate health policies and clinical protocols for human trafficking. Opportunity exists for nursing organizations to leverage the collective professional skill sets of their members to efficiently galvanize the nursing profession to effectively respond to persons encountered in clinical settings who are abused and exploited through trafficking.

Partners for Vulnerable Youth and the Alliance for Children in Trafficking: Using the Policy Circle Model as a Framework for Change

The National Association of Pediatric Nurse Practitioners (NAPNAP) was the first-ever professional organization for nurse practitioners (NPs) and remains dedicated to advancing the NP role to improve child health. In 2016, NAPNAP Partners for Vulnerable Youth (NPVY) was established as a 501(c)(3) to take a leadership role in advocacy and education efforts for at-risk pediatric populations. NPVY launched the Alliance for Children in Trafficking (ACT), with far-reaching implications for nursing leadership to leverage expertise from collective organizational membership to improve health. This paper will demonstrate use of the Policy Circle model as a framework for planned policy change.

White Paper: Recognizing Child Trafficking as a Critical Emerging Health Threat

Human trafficking is a pandemic human rights violation with an emerging paradigm shift that reframes an issue traditionally seen through a criminal justice lens to that of a public health crisis, particularly for children. Children and adolescents who are trafficked or are at risk for trafficking should receive evidence-based, trauma-informed, and culturally responsive care from trained health care providers (HCPs). The purpose of this article was to engage and equip pediatric HCPs to respond effectively to human trafficking in the clinical setting, improving health outcomes for affected and at-risk children. Pediatric HCPs are ideally positioned to intervene and advocate for children with health disparities and vulnerability to trafficking in a broad spectrum of care settings and to optimize equitable health outcomes.

Share our stories: An exploration of the healthcare experiences of child sex trafficking survivors

BACKGROUND

The trafficking of children and adolescents is widespread, and pediatric providers are on the front line. Current research demonstrates that trafficked children do access health care. However, few studies describe these interactions from their perspectives. In order to elucidate the healthcare experiences of sex trafficked children, we designed a qualitative study utilizing semi-structured interviews to explore their health care interactions.

PARTICIPANTS AND SETTING

Homeless youth currently aged 18-21 who were sex trafficked before age 18.

METHODS

Semi-structured interviews were conducted with seventeen youth who met the study criteria. Interview transcripts were coded and analyzed using constant comparative methods. Themes were inductively extracted by consensus with the study team, and thematic saturation was determined when no new themes emerged.

RESULTS

Themes included: victims endured serious injuries and illnesses without being brought to medical attention, traffickers limited victims' access to care, logistical barriers limited access, traffickers directed victims to lie to providers, and medical providers rarely separated victims to interview them separately resulting in missed opportunities.

CONCLUSIONS

These themes illustrate the experiences of sex trafficked youth experiencing homelessness and provide pediatric practitioners the opportunity to become more informed and equipped to recognize them. They also highlight serious health consequences of not being identified and egregious examples of providers exhibiting denial or inappropriate responses to their disclosure.

The Role of Nursing in the School Setting to Lead Efforts to Impact Child Trafficking: An Integrative Review

Registered professional and advanced practice nurses in the school setting, as a specialized practice entity, are leaders in implementation of evidence-based practice, skilled coordinators of care, advocates for students, and experts in designing systems assisting individuals and communities to reach full potential. Child trafficking (CT) is an emerging public health threat impacting safety and well-being of students present in the school setting. This literature review identified four themes in five studies: (1) training impacts nurses' knowledge, awareness, and attitudes; (2) school nursing is underrepresented in training, education, prevention, response, and research; (3) lack of collaboration exists between school staff and school nurses; and (4) formal education and length of experience impact levels of interventions school nurses are able to provide. School nurses are opportunely situated to intervene as advocates for vulnerable children to develop a coordinated, effective response to CT risk factors, mitigating risk and fostering resiliency with systems-based change.

Human Trafficking of Children: Nurse Practitioner Knowledge, Beliefs, and Experience Supporting the Development of a Practice Guideline: Part Two

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.