PEARR tool training and implementation: building awareness of violence and human trafficking in a hospital system

Introduction

Health professionals have an opportunity to assist patients who are experiencing many types of violence, including human trafficking; however, current approaches are often not person-centered. The Provide privacy, Educate, Ask, Respect and Respond (PEARR) Tool, a recognized screening tool in the U.S., is a structured conversation guide for health professionals on how to provide trauma-sensitive assistance to patients who may be experiencing such violence, including human trafficking. This is the first study to evaluate the PEARR Tool and its use in hospital settings.

Methods

A U.S.-based health system adopted the PEARR Tool as part of its Abuse, Neglect, and Violence policy and procedure. To support successful adoption, the health system also developed educational modules on human trafficking and trauma-informed approaches to patient care, including a module on the PEARR steps. In October 2020 and June 2021, a voluntary "PEARR Tool Training and Implementation Survey" was distributed to emergency department staff in three hospitals. The survey consisted of 22 questions: eight demographic and occupation related questions; five questions related to the education provided to staff; and, nine questions related to the use of the PEARR Tool in identifying and assisting patients.

Results

The overall findings demonstrate a general increase in awareness about the prevalence of human trafficking, as well as a significant increase in awareness about the implementation of the PEARR Tool. However, the findings demonstrate that most respondents were not utilizing the PEARR Tool between October 2020 and June 2021. Most reported that the reason for this was because they had not suspected any of their patients to be victims of abuse, neglect, or violence, including human trafficking. Of those that had utilized the PEARR Tool, there was a marked increase in staff that reported its usefulness and ease of access when caring for patients.

Discussion

The COVID-19 pandemic posed many challenges during this study, including delays in staff education, changes in education format and delivery, and strains on staff. Initial data regarding the use of the PEARR Tool is promising; and additional research is recommended.

Sleep Disturbances and Hygiene of Adolescent Female Survivors of Domestic Minor Sex Trafficking

INTRODUCTION

This cross-sectional quantitative study investigated the sleep hygiene and disturbances of adolescent female survivors of domestic minor sex trafficking (DMST) compared to an online sample of community-dwelling adolescent females.

METHOD

Community-dwelling adolescent females (aged 13-17 years, n = 61) and survivors of DMST housed in residental care (aged 12-17 years, n = 19) completed the Children's Report of Sleep Patterns (adolescent version). Descriptive statistics on sleep health in both samples were computed and compared using chi-square and t-tests.

RESULTS

Among the survivors of DMST, the majority reported insufficient sleep duration, okay-to-poor sleep quality, waking thirsty, and frequent nightmares. Compared with community-dwelling adolescents, survivors of DMST had more symptoms of insomnia, sleepiness, nightmares, and waking thirsty (p < .05).

DISCUSSION

Sleep disturbances among adolescent female survivors of DMST may be more prevalent than in community-dwelling adolescent females. Further empirical research on appropriate assessment and trauma-informed treatment of sleep in this population is needed.

An eight-year analysis of child labor trafficking cases in the United States: Exploring characteristics, and patterns of child labor trafficking

BACKGROUND

Child labor trafficking in the U.S. has proven to be difficult to research and very little is known about the scope, severity, or common characteristics of child labor trafficking situations.

OBJECTIVE

The purpose of this study was to explore if child labor trafficking exists in the U.S. through investigating the labor trafficking cases filed from 2011 to 2018. Once identified, the contributing vulnerability factors and case outcomes were analyzed to build new knowledge about child labor trafficking in the U.S.

PARTICIPANTS AND SETTINGS

This study explores 34 cross-section child labor trafficking criminal cases in the U.S. resulting in 52 child labor trafficking victims being identified.

METHODS

Cross sectional child labor trafficking case data collected through online searches were analyzed and described.

RESULTS

The majority of the cases (73.5%, n = 25) were child labor trafficking only while 26.5% (n = 9) were both sex trafficking and labor trafficking. Fifty-eight percent of the victims were children from countries outside of the U.S. Victims in more than half of the cases (n = 18) identified their relationship with their traffickers as "friendly strangers/acquaintances". Techniques for recruitment and retention used by the child labor traffickers included psychological, physical, and sexual violence along with offering shelter to the victims.

CONCLUSIONS

Recommendations include the need to increase research and awareness about child labor trafficking in the United States, to develop and implement civil child protection, and to improve child victim benefits and compensation in the United States.

Review of Published Curriculum on Sex Trafficking for Undergraduate Medical Trainees

Educational councils and medical societies recommend that medical students learn to recognize and care for victims of sex trafficking. Previous research has found that healthcare providers are one of the few professionals to interact with sex trafficking victims during exploitation. This review evaluates currently published curricular and extracurricular U.S. medical education resources. A literature review of MEDLINE, PubMed, Embase, MedEdPORTAL, Google Scholar, and Google was conducted in December 2018 to January 2019 using the search terms: human trafficking OR sex traffic OR sex violence OR sex work OR sex exploitation OR child prostitution AND education, medical, undergraduate OR students, medical OR medical student or medical education OR education, medical. The inclusion criteria included informational educational materials for medical students on sex trafficking. Studies were excluded for: non-English language, empirical research on sex trafficking, nonhealth or nonundergraduate medical students, and resources focused on other sexual health topics. The database literature search uncovered 64 scholarly articles. Inclusion criteria were met by 4 articles; 2 articles were added from a reference review, and an additional 5 articles were found from an Internet search. These 11 resources provided educational materials relevant to medical students on sex trafficking themes, including scope, consequences, identification, treatment, referral, legal, security, and prevention. The curricula demonstrated a wide variability in delivery method, length, and scope. A limited published sex trafficking curriculum exists for medical student learners. Future research evaluating unpublished curricula within U.S. medical schools is necessary to coordinate efforts for standardized and robust sex trafficking education.

Male and female juveniles arrested for murder: a comprehensive analysis of U.S. data by offender gender

Murders committed by juveniles remain a serious concern in the United States. Most studies on juvenile homicide offenders (JHOs) have used small samples and have concentrated on male offenders. As a result, little is known about female JHOs and how they differ from their male counterparts on a national level. This study utilized the Supplementary Homicide Report (SHR) database to examine more than 40,000 murders committed by male and female juvenile offenders from 1976 to 2005. This research effort, the most expansive to date, replicated previous findings with respect to gender differences using bivariate and multivariate analyses. As predicted, six variables used to test eight hypotheses with respect to male and female JHOs in single-victim incidents were significant (victim age, victim-offender relationship, murder weapon, offender count, victim gender, and homicide circumstance). Regression analysis revealed that all variables remained significant when entered into the model. This article concludes with a discussion of our findings and directions for future research.

Examining the sexual offenses of female juveniles: The relevance of childhood maltreatment

Research on female juvenile sex offenders is limited by small clinical samples. Little is known about the characteristics of female sexual offending and how it is related to child maltreatment. This study examines data from the case histories of 118 female juvenile sex offenders. In contrast to portrayals in previous research, this study shows that female sex offenders are not a homogeneous group. Findings also included differentiation between female juvenile sexual offenders with a history of child maltreatment and those without a history of child maltreatment. Female juvenile sex offenders who had a history of child maltreatment were more likely to have a current mental health diagnosis and experience clinical levels of anger--irritability and depression--anxiety than those without a history of child maltreatment. The impact of a history of sexual abuse for female juvenile sex offenders was found to be important with regard to higher levels of coercion of their sexual abuse victims. Important distinctions are highlighted that have implications for female-specific assessment, treatment, and prevention.

Adolescent female murderers: characteristics and treatment implications

This study examines individual and family characteristics of a population of 29 adolescent females charged with homicide or attempted homicide in the juvenile justice system. The purpose of this study is to contribute to the limited knowledge about adolescent females charged with homicide. Data were collected including the MAYSI-2, a risk classification instrument, and social, educational and family histories. Findings include high rates of reported substance use, delinquent peers, early indicators of mental health problems, and limited control and supervision by parents. The most common weapon used was a car and the most common victim was a known person. A comparison was conducted on girls charged with homicide during the commission of another crime or committed during a conflict. The conflict group was found to victimize friends and family significantly more often than the crime group. The crime group showed higher use of alcohol and drugs, used a gun more and had co-offenders at a higher rate. A profile was developed to describe the typical adolescent female homicide offender found in this study. Treatment recommendations and future research were discussed.

Characteristics and predictors of self-mutilation: a study of incarcerated women

BACKGROUND

Research on self-mutilating behaviour and incarcerated adults has found that nearly 50% of people in prison participated in it (Holley and Alborleda-Florez, 1988). This is an enormous liability for the criminal justice system as well as a human concern.

AIMS/HYPOTHESES

The research question for this study was to explore whether a history of childhood abuse in a sample of incarcerated women would increase their likelihood of self-mutilation.

METHODS

Participants were 256 female inmates from five prisons in a large southern state who volunteered to attend a 12-week trauma and abuse psychosocial intervention group. The participants were evaluated for childhood abuse, criminal history, risk-taking behaviour and self-mutilation. Data are presented regarding individual, criminal, abuse, family and risk-taking behaviours comparing self-mutilators (n = 109) with non-self-mutilators (n = 147).

RESULTS

The self-mutilation group was more likely to report higher rates of emotional, sexual and physical abuse and on clinical significance scales of anxiety, depression, dissociation, impaired self-reference, anger, tension reduction and intrusive experiences. The self-mutilation group was also younger and was more often Caucasian. The results of the regression model suggest that a history of suicide attempts, emotional abuse, sexual abuse, bingeing and vomiting and impaired self-reference are predictors of self-mutilation.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

Recommendations and implications for practice are discussed.