Responding to human trafficking among refugees: prevalence and test accuracy of a modified version of the adult human trafficking screening tool.

BACKGROUND: Human trafficking is a human rights violation and urgent public health challenge. It involves the exploitation of a person by means of force, intimidation or deceit and causes severe health risks. Though it occurs all over the world, its true extent is still unknown. Refugees are especially vulnerable to human trafficking due to language barriers and difficult living conditions. Therefore, the purpose of this study was to estimate the prevalence and design a screening tool to identify survivors of all forms of human trafficking among refugees in a German state registration and reception centre. METHODS: In cooperation with the local authorities and the Ministry of Justice and for Migration Baden-Württemberg, we interviewed newly arrived refugees at an initial reception centre in Southern Germany to assess the prevalence of human trafficking. We used both a combination of the Adult Human Trafficking Screening Tool and a publication by Mumma et al. to assess all forms of human trafficking. RESULTS: In total, 13 of the 176 refugees had experienced trafficking, which corresponded to a prevalence of 7.3% (95%-CI = [3.5%, 11.3%]). Across all languages the questionnaire had a sensitivity of 76.9% and a specificity of 84.0% at a recommended cut-off of six positive responses. The recommended cut-off differed slightly for the Arabic, Farsi, Turkish, and English version. In an exploratory descriptive analysis on subregions, refugees from West Africa had a substantially higher prevalence (33.3%, 8 out of 24) for human trafficking within our sample, especially women. However, when we excluded this region from our analysis, we found no significant gender difference for the rest of the sample. CONCLUSIONS: The high prevalence of trafficking in most regions, regardless of gender, suggests that more effort is needed to identify and protect all trafficked persons. The designed screening tool seems to be a promising tool to detect an especially vulnerable group of refugees and provides assistance in identifying survivors of human trafficking.

Adverse Childhood Experiences, Women Who Are Sex Trafficked, and Social Service Utilization: Implications for Social Work.

The aim of this study was to examine the associations between adverse childhood experiences (ACEs) and the high levels of social service usage by women who are sex trafficked. Fifty (N = 50) women who were sex trafficked were surveyed using purposive and snowball sampling methods. The ACEs score for respondents ranged from 2 to 10 with an average score of 7.4 (SD = 2.3). Emotional and sexual abuse tied at 88 percent as the most frequently cited ACEs among the women in this sample. The prevalence of ACEs was significantly higher in this sample compared with known estimates in similar populations, ranging from 20 percent to 54 percent (p < .001). Considering the well-established link between ACEs and poor health outcomes, these findings point to the need for innovative and targeted social service provisions to women who were formerly sex trafficked that take into consideration the high level of ACEs of the women. Given the sociodemographic diversity of this sample, there is a need for services that are trauma-informed, innovative, and culturally sensitive in a variety of social service settings.

Experiences of child sex trafficking identification among Ontario pediatric emergency department healthcare providers: A qualitative study.

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.

Medicolegal assessment of human trafficking victims. Descriptive study of a series of forensic cases in Catalonia (Spain). / Valoración médico-legal de las víctimas de trata de seres humanos. Estudio descriptivo de una serie de casos forenses en Cataluña (España).

BACKGROUND AND OBJECTIVE: Human trafficking or contemporary slavery is the recruitment and transfer of people by force or deception for sexual, labour or other types of exploitation. Although the violence, abuse and deprivation that trafficking entails are a threat to the health of its victims, in Spain the clinical or forensic data available in this regard is scarce. At the Institute of Legal Medicine and Forensic Sciences of Catalonia (IMLCFC), a unit specialized in the forensic assessment of these victims was created. The objective of this work was to describe a series of forensic cases of trafficking victims. MATERIAL AND METHOD: Retrospective study of victims in judicial cases opened for an alleged crime of human trafficking registered in the IMLCFC until 06/30/2023. RESULTS: 57 different victims were registered. The majority were women (71.9%). The average age was 30.5 years (s.d. 10.31). All the victims were foreigners, mostly from Latin America (45.5%). The exploitation was mainly sexual (61.4%). There were some sociodemographic differences and in the conditions and consequences of trafficking between victims of sexual exploitation and the rest. Mental health problems were very common in all victims at the time of the assessment (87.5%). CONCLUSIONS: The consequences of trafficking on health, especially mental health, are notable and the forensic assessment of victims is valuable in judicial proceedings. It is necessary to deepen our knowledge of the phenomenon in our environment.

Recognizing and intervening in child sex trafficking.

Know the risk factors, choose from among 3 validated screening tools, and use a trauma-informed approach with those likely involved in trafficking.

Confidential Screening for Sex Trafficking Among Minors in a Pediatric Emergency Department.

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.

Violence against pregnant women in the experience of the rape centre of Turin: Clinical and forensic evaluation.

Pregnant women can be victims of violence: as a matter of fact, far from being a protective factor, pregnancy can trigger or worsen episodes of abuse. Studies conducted by the WHO highlight that its incidence fluctuates between 1% and 28%. Therefore violence during pregnancy is endemic all over the world and involves all social strata. We analysed 113 medical records concerning pregnant women (average age 27.9 ± 6.0 years, 80 foreigners), who turned to the Centro Soccorso Violenza Sessuale, one of the two Italian Rape Centre, in Turin between January 1st, 2005 and December 31st, 2017. Fifty-three women were visited in the first trimester, 41 in the second, and 16 in the third, while 3 during the puerperium. The current partner was accused to be the abuser by the 84.4% of the Italian women and by the 69.2% of the foreigners. Sixty-eight women suffered multiple forms of violence, while 98 suffered only physical violence, and 3 reported only sexual abuse. According to 20 women, violent episodes increased during pregnancy. The clinical history of these women was characterized by some recurrent physical symptoms, such as pelvic pain, abdominal pain, facial pain and headache and 54 women presented injuries (abrasions and ecchymosis). Our results confirm that violence in pregnancy is a social and public health problem. Therefore it is important that the health personnel should be prepared not only to care for women seeking help, but above all its better preparation could also identify victims of violence, which do not report abuse.

Child Labor Trafficking Essentials for Forensic Nurses.

Human trafficking is a form of modern-day slavery and is a significant pediatric healthcare problem in the United States. The term "human trafficking" encompasses both sex and labor trafficking. Sex trafficking, especially child sex trafficking, has received significant lay and professional attention. However, few efforts have focused on learning more about youth experiencing labor trafficking in the United States. Pediatric healthcare providers, including forensic nurses, are likely to encounter victims of child labor trafficking in their practice. A basic understanding of child labor trafficking will assist forensic nurses in timely identification of and appropriate intervention for victims. In this article child labor trafficking is discussed in terms of definition, epidemiology, history, risk factors, consequences, identification, and implications for practice.

Challenges to pre-migration interventions to prevent human trafficking: Results from a before-and-after learning assessment of training for prospective female migrants in Odisha, India.

BACKGROUND: Awareness-raising and pre-migration training are popular strategies to prevent human trafficking. Programmatic theories assume that when prospective migrants are equipped with information about risks, they will make more-informed choices, ultimately resulting in safe migration. In 2016, India was estimated to have 8 million people in modern slavery, including those who migrate internally for work. Work in Freedom (WiF) was a community-based trafficking prevention intervention. This study evaluated WiF's pre-migration knowledge-building activities for female migrants in Odisha to prevent future labour-related exploitation. METHODS: Pre- and post- training questionnaires were administered to women (N = 347) who participated in a two-day pre-migration training session. Descriptive analysis and unadjusted analyses (paired t-tests, McNemar's tests, Wilcoxon signed ranks tests) examined differences in women's knowledge scores before and after training. Adjusted analyses used mixed effects models to explore whether receiving information on workers' rights or working away from home prior to the training was associated with changes in scores. Additionally, we used data from a household survey (N = 4,671) and survey of female migrants (N = 112) from a population sample in the same district to evaluate the intervention's rationale and implementation strategy. RESULTS: Female participants were on average 37.3 years-old (SD 11) and most (67.9%) had no formal education. Only 11 participants (3.2%) had previous migration experience. Most participants (90.5%) had previously received information or advice on workers' rights or working away from home. Compared to female migrants in the population, training participants were different in age, caste and religion. Awareness about migration risks, rights and collective bargaining was very low initially and remained low post-training, e.g. of 13 possible migration risks, before the training, participants named an average of 1.2 risks, which increased only slightly to 2.1 risks after the training (T(346) = -11.64, p<0.001). Changes were modest for attitudes about safe and risky migration practices, earnings and savings. Before the training, only 34 women (10.4%) considered migrating, which reduced to 25 women (7.7%) post-training (X2 = 1.88, p = 0.169)-consistent with the low prevalence (7% of households) of female migration locally. Women's attitudes remained relatively fixed about the shame associated with paid domestic work. Survey data indicated focusing on domestic work did not correspond to regional migration trends, where women migrate primarily for construction or agriculture work. CONCLUSION: The apparent low effectiveness of the WiF short-duration migration training may be linked to the assumption that individual changes in knowledge will lead to shifts in social norms. The narrow focus on such individual-level interventions may overestimate an individual's agency. Findings indicate the importance of intervention development research to ensure activities are conducted in the right locations, target the right populations, and have relevant content. Absent intervention development research, this intervention suffered from operating in a site that had very few migrant women and a very small proportion migrating for domestic work-the focus of the training. To promote better development investments, interventions should be informed by local evidence and subjected to rigorous theory-based evaluation to ensure interventions achieve the most robust design to foster safe labour migration for women.

Sex Trafficking in the United States: A Scoping Review.

PURPOSE: Human trafficking is a public health social work issue. This review aimed to present the current state (nature and extent) of sex trafficking research, categorize best practices, and identify recommendations for professionals. METHODS: Comprehensive literature searches of online databases were conducted to identify eligible articles from January 2000 to March 2019. RESULTS: The search yielded 467 studies, 87 met the predetermined criteria for inclusion. Seven themes identified: awareness, identification, at-risk populations, health issues, implementation of trafficking legislation, service and program implementation, and exploiters. DISCUSSION AND IMPLICATIONS FOR PRACTICE: Findings indicate the need for additional research to determine the most effective practices to increase awareness and identification, widespread TVPA implementation, reduce risk factors and resulting health disparities, offer services to survivors and prevention of potential victims. CONCLUSION: There should be significant efforts to enhance all sex trafficking research in the United States to implement effective, sustainable and evidence-based interdisciplinary interventions.

Residential instability, running away, and juvenile detention characterizes commercially sexually exploited youth involved in Washington State's child welfare system.

BACKGROUND: Federal policy in 2015 expanded the definition of "child abuse" to include human trafficking. As a result, child welfare agencies are newly responsible for identifying and providing services for youth in state care who are or at-risk of commercial sexual exploitation. OBJECTIVE: To describe the demographics, state-dependent living situations, and juvenile detention usage of state-dependent commercially sexually exploited youth. PARTICIPANTS AND SETTING: Eighty-three state-dependent youth (89.2 % female, mean age at identification = 15.5 years, SD = 1.5, Range = 11.7-19.1 years) who were confirmed or strongly suspected of commercial sexual exploitation. METHODS: Secondary analysis of lifetime administrative record data from child welfare and juvenile justice systems using descriptive statistics. RESULTS: Youth experienced early and frequent contact with the child welfare system. Youth experienced an average of 27 living situation disruptions while in the care of child welfare, with a disruption an average of every 71 days, primarily due to running away. Nearly 9 out of 10 youth had at least one runaway episode, and for these youth, there were an average of 8.6 runaway episodes. Three out of four youth had at least one juvenile detention episode, and for these youth, the average number of detention episodes was 9.2. CONCLUSIONS: We provide the context of a cycle of multisystem entanglement, whereby running away may be both a response to and cause of further system involvement and commercial sexual exploitation, and call for evidence-based interventions focused on reducing running away for these youth.

Recognizing Victims of a Hidden Crime: Human Trafficking Victims in Your Pediatric Trauma Bay.

Human trafficking is the second largest criminal industry in the United States and almost half of the victims are children. This crime against children is referred to as domestic minor human sex trafficking (DMHST). The majority DMHST victims access health care, often at an emergency department, at some point during their captivity. Trafficking of minors has been cited as the most underreported form of child abuse making education on this topic essential for all health care providers to help meet the needs of this population. A case study provides an illustration of a pediatric trauma patient who was a victim of DMHST and presented to an emergency department for care. As nurses who care for pediatric trauma patients in all settings strive to learn more about child abuse, topics in DMHST should also be included in these educational activities.

Influence of Survivors' Entrapment Factors and Traffickers' Characteristics on Perceptions of Interpersonal Social Power During Exit.

Typically examined in terms of understanding vulnerabilities to and the scope of human trafficking, not much is understood about interpersonal dynamics in human trafficking experiences. This article explores human trafficking victims' (n = 31, female, international) perceptions of traffickers' interpersonal social power during the exiting phase of the trafficking experience. Findings from this study revealed that entrapment factors and shared common characteristics between victim and trafficker prior to trafficking influenced perceptions of interpersonal social power. Understanding victims' perceptions of interpersonal social power is critical to developing trauma-informed targeted services for exiting assistance and aftercare services for this population.

Exploring the relationship between domestic minor sex trafficking myths, victim identification, and service provision.

BACKGROUND: The onus of sex trafficking victim identification currently falls to professionals in youth-serving organizations. Accurate identification of domestic minor sex trafficking victims (DMST) and subsequent delivery of services can be impeded by common myths related to human trafficking. OBJECTIVE: Determine if human service professionals understand the difference between myths and facts pertaining to sex trafficking and if their knowledge affects subsequent service provision. PARTICIPANTS AND SETTING: Professionals (n = 69) represented youth-serving organizations from a large metropolitan city in the Southwestern United States. METHODS: Data was collected in a cross-sectional survey from March 2016 to April 2016. RESULTS: A minority of professionals working in youth-serving organizations believed DMST myths, though administrators most commonly believed the myth that force, fraud, or coercion are required in DMST. Most professionals could not provide an accurate number of victims identified and felt their organizations would benefit from further training. A statistically significant relationship (p < .05) was observed between the belief that "elements of physical force, restraint, bondage, and/or violence" must be present in DMST and participants' ability to identify victims served by their organizations in a given year. Organizations reported that they failed to provide services requested by DMST victims. CONCLUSIONS: The persistence of DMST myths likely hampers victim identification and tailored service delivery. Cross-sector collaborations are needed to ensure victims' needs are met. Trainings are needed that cover the legal definitions of domestic minor sex trafficking and victim identification and train on accurate identifiers. Training initiatives should include survivors to ensure practices are trauma-informed.

Commercial Sexual Exploitation of Youth in the United States: A Qualitative Systematic Review.

BACKGROUND: Homeless, runaway, and transgender youth are at high risk for commercial sexual exploitation in the United States. Research examining this phenomenon is growing but requires synthesis to facilitate its use by professionals who serve this population. The purpose of this review was to aggregate the qualitative evidence regarding commercially sexually exploited youth (CSEY) in the United States. METHODS: The search included published and unpublished qualitative studies with current or former CSEY who reside in the United States. RESULTS: There were 19 studies included in the review with a total of 795 participants. Eight themes were identified and grouped into three broader categories: experiences that preceded sex work entry, experiences that facilitated sex work continuation, and experiences that facilitated sex work exit. CONCLUSIONS: Understanding the barriers and facilitators of commercial sexual exploitation can inform the development of interventions that address the needs of CSEY and youth at risk for exploitation. The results of this review highlight the social and economic influences as well as the role of positive and negative reinforcements involved in sex work entry, its continuation, and exit. Needs for services, research, and advocacy are also discussed.

Responding to the health needs of trafficked people: A qualitative study of professionals in England and Scotland.

Trafficked people require timely and ongoing access to healthcare services. Yet, many encounter difficulties accessing and utilising healthcare services, both while in situations of exploitation and after their escape. This research investigated barriers that hinder healthcare providers from identifying, providing care and making necessary referrals for trafficked people in the United Kingdom (UK). Semi-structured, face-to-face interviews were conducted with healthcare (n = 23) and non-health (n = 27) professionals with relevant policy or practical experience related to human trafficking in the UK. Topic guides covered identifying, referring and providing care to trafficked people. Transcripts were analysed using thematic analysis. Four interconnected themes emerged: trafficked persons' entitlements to healthcare, availability of healthcare resources, providers' knowledge about trafficking, and the particular needs of trafficked individuals. Providers explained that policies limiting entitlements to healthcare created significant obstacles to care, as did the inadequate resourcing of interpreter services, trafficking support services, and specialist mental health services. Few healthcare professionals reported having received training on responses to trafficked people and most were unaware of support options and referral routes. Healthcare professionals will be better equipped to serve trafficked individuals if they are provided training to identify and respond to human trafficking, guidance on referral and support options and entitlements to care. Simultaneously, improving trafficked people's healthcare access and use will also require government interventions to ensure they are not unjustifiably denied healthcare.

Evidence-based Care of the Human Trafficking Patient.

Human trafficking is the intentional exploitation of vulnerable individuals for the personal gain of the exploiter and is now recognized as an emerging public health care priority. Health care providers are well positioned to identify and assist trafficked individuals as well as those who may be at risk for exploitation. Trauma informed care is essential to identify victims and evaluate the impact of traumatic stress while highlighting survivors' strengths and supporting their resiliency. Human trafficking demographics, including mental and physical health problems, health considerations, risk factors, screening, implications for practice, and national resources, are reviewed.

Children at Work, Child Labor and Modern Slavery in India: An Overview.

There is a large child work force in India reported to be about 40 million. Child labor is being regarded as a form of modern slavery, as children are forced to work or have no choice to refuse work. Children are employed in a variety of occupations, many of which are hazardous. Exposure to machinery, pesticides, dust in agricultural work and fumes, chemicals, acids, cotton and wool fiber in other forms of work is detrimental to health. A large number are held in bonded servitude. In urban areas, children are employed as domestic helpers and engaged in eateries and auto-repair work. Trafficking and trading of children for work and sexual slavery are also major concerns. Poverty and illiteracy are root causes of child labor, but iniquitous societal attitudes are responsible for abuse and exploitation. Working children are deprived of proper health care and education, and lose their childhood and dignity. Several legal measures exist to prevent child labor and protect them from harm, but are thwarted by the distressing socioeconomic conditions. Although child labor would be difficult to abolish, exploitation can be prevented with concerted efforts of the government agencies, professional bodies and the civil society.