Sex trafficking survivors' experiences with the healthcare system during exploitation: A qualitative study.

While most individuals who have experienced sex trafficking will seek medical attention during their exploitation, very few will be identified by healthcare professionals (HCP). It constitutes a lost opportunity to provide appropriate support, resources, and services. In this study, we examined the experiences of accessing care of sex trafficking survivors in the Greater Montreal area and their interactions with HCPs to inform trafficking education programs for HCPs and allied health professionals regarding the needs of this patient population. We conducted seven semi-structured in-depth interviews with purposively selected sex trafficking survivors participating in "Les Survivantes," a program of the SPVM (Service de Police de la Ville de Montréal), designed to support trafficked individuals' exit journey. We used interpretive description to understand the lived experiences of trafficked individuals with direct applications to clinical education and care. Our results revealed that trafficked individuals accessing care present with a fragile trust in HCPs and how HCPs have many opportunities to conduct comprehensive examinations and query trafficking. Trafficked individuals' initial trust in HCPs can be strengthened by non-judgemental approaches or damaged by stigmatizing conduct, serving to isolate further and alienate this patient population. Health professionals' attitudes combined with healthcare settings' cultures of care (i.e., community vs emergency) and exposure to marginalized groups were key influencers of survivors' perception of healthcare interactions. The findings also emphasized the importance of routinely querying trafficking through sensitive psychosocial questioning based on observation of trafficking cues. Survivors reported a list of trafficking cues to recognize and emphasized the importance of trust as a condition of disclosure. Finally, survivors identified the need for exit planning to be centered around trafficked individuals' agency and holistic needs, and for streamlined community-based multidisciplinary collaboration to better serve this population. Our results highlight that most challenges experienced by trafficking survivors in accessing care and resources are modifiable through HCP education and training. Our study also provides new insights and concrete advice to improve care and support throughout the exiting process. We argue that healthcare services for this population be modeled harm reduction approaches that focus on victims' agency and needs, independent of their desire to exit trafficking. We emphasize the urgent need for proper case management and intersectoral and multidisciplinary care coordination in community-based settings as well as facilitated access to mental health support.

Therapeutic touch is not therapeutic for procedural pain in very preterm neonates: a randomized trial.

BACKGROUND: Preterm neonates below 30 weeks' gestational age undergo numerous painful procedures. Many management approaches are not appropriate for this population. Therapeutic Touch, an alternative approach based on the theory of energy medicine, has been shown to promote physiological stability in preterm neonates and reduce pain in some adult studies. The objective was to determine whether Therapeutic Touch is efficacious in decreasing pain in preterm neonates. METHODS: Infants < 30 weeks' gestational age participated in a randomized control trial in 2 level III neonatal intensive care units. All evaluations, analyses, and heel lance procedure were conducted with only the therapist knowing the group assignment. Immediately before and after the heel lance procedure, the therapist performed nontactile Therapeutic Touch (n = 27) with infant behind curtains, leaving the curtained area for the heel lance, performed by another. In the sham condition (n = 28), the therapist stood by the incubator with hands by her side. The Premature Infant Pain Profile was used for pain response and time for heart rate to return to baseline for recovery. Heart rate variability and stress response were secondary outcomes. RESULTS: There were no group differences in any of the outcomes. Mean Premature Infant Pain Profile scores across 2 minutes of heel lance procedure in 30-second blocks ranged from 7.92 to 8.98 in the Therapeutic Touch group and 7.64 to 8.46 in the sham group. INTERPRETATION: Therapeutic Touch given immediately before and after heel lance has no comforting effect in preterm neonates. Other effective strategies involving actual touch should be considered.

Recorded maternal voice for preterm neonates undergoing heel lance.

PURPOSE: To determine if a recording of a mother's voice talking soothingly to her baby is useful in diminishing pain in newborns born between 32 and 36 weeks' gestational age (GA) during routine painful procedures. BACKGROUND: While maternal skin-to-skin contact has been proven efficacious for diminishing procedural pain in both full-term and preterm neonates, it is often not possible for mothers to be present during a painful procedure. Because auditory development occurs before the third trimester of gestation, it was hypothesized that maternal voice could substitute for maternal presence and be effective in diminishing pain response. SUBJECTS: Preterm infants between 32 and 36 weeks' GA (n = 20) in the first 10 days of life admitted to 2 urban university-affiliated neonatal intensive care units. DESIGN AND METHODS: Crossover design with random ordering of condition. Following informed consent, an audio recording of the mother talking soothingly to her baby was filtered to simulate the mother's voice traveling through amniotic fluid. A final 10-minute recording of repetition of mothers' talking was recorded with maximum peaks of 70 decibels (dB) and played at levels ranging between 60 and 70 ambient decibels (dbA), selected above recommendations of the American Academy of Pediatrics in order to be heard over high ambient noise in the settings. This was played to her infant by a portable cassette tape player 3 times daily during a 48-hour period after feedings (gavage, bottle, or breast). At the end of 48 hours when blood work was required for clinical purposes, using a crossover design, the infant underwent the heel lancing with or without the recording being played. The order of condition was randomized, and the second condition was within 10 days. The Premature Infant Pain Profile (PIPP) was used as primary outcome. This is a composite measure using heart rate, oxygen saturation, 3 facial actions, behavioral state, and gestational age. This measure has demonstrated reliability and validity indexes. RESULTS: There were no significant differences between groups on the PIPP or any of the individual components of the PIPP except a lower oxygen saturation level in the voice condition following the procedure. The second condition, regardless of whether it was voice or control, had higher heart rate scores and lower oxygen saturation scores even in the prelance baseline and warming phases. Order did not affect PIPP scores or facial actions. CONCLUSIONS: Different modalities of maternal presence would appear to be necessary to blunt pain response in infants, and recorded maternal voice alone is not sufficient. The loudness of the recording may have obliterated the infant's ability to discern the mother's voice and may even have been aversive, reflected in decreased oxygen saturation levels in the voice condition. Preterm neonates of 32 to 36 weeks' gestation may become sensitized to painful experiences and show anticipatory physiological response.