Frontline Medical Professionals' Ability to Recognize and Respond to Suspected Youth Sex Trafficking.

OBJECTIVES: Many youth sex trafficking victims visit health care facilities while being trafficked. Little is known regarding whether frontline medical professionals recognize risk factors or are aware of effective interviewing approaches to identify and intervene for youth victims. The aim of the present study was to assess frontline medical professionals' knowledge of youth sex trafficking, adolescent development, and forensically informed interviewing to provide guidance for professional training. METHODS: Two hundred seventy-seven frontline medical professionals [first responders and emergency department (ED)/clinical professionals] in Southern California completed an online survey about their background, training, perceptions of likely youth sex trafficking scenarios, knowledge of adolescent development, sex trafficking, and forensically informed interviewing. RESULTS: Nearly all professionals recognized risk and the need to collect additional information, yet few (1% first responders and 12% ED) recognized that risk as sex trafficking. Forty-six percent of first responders also indicated that responding to nonmedical needs was outside of their job responsibilities. A mixed model analysis of covariance revealed significant interactions of gender by domain ( P = 0.01) and domain by training ( P = 0.045). Women evidenced better knowledge (78% accuracy) about sex trafficking and interviewing (73%) than adolescent development (64%), whereas men were more accurate with sex trafficking (64%) than adolescent development (61%) and interviewing (62%). For domain by training, tests of within subjects' contrasts showed a quadratic relation ( P = 0.02) was the best fit model, where training was most strongly associated with accuracy in sex trafficking knowledge. CONCLUSIONS: Frontline medical professionals are lacking in their knowledge of youth sex trafficking, interviewing, and especially adolescent development. An area in which interventions can be targeted is with training (because it emerged in a significant interaction). Training could combat unrepresentative depictions of victims, improve understanding of common victim characteristics, and highlight how forensically informed interviewing can improve medical professionals' ability to gather crucial history about victims' experiences and needs.

Youth survivor perspectives on healthcare and sex trafficking.

PURPOSE: This study aimed to assess the perspectives of youth survivors of sex trafficking on healthcare to improve care for this vulnerable and often unrecognized population. DESIGN AND METHODS: Semi-structured focus groups were conducted with eight survivors in Southern California who interacted with the healthcare system while being sex trafficked. Interviews were audio- and/or video-recorded and transcribed verbatim. The analysis utilized a grounded theory approach, where researchers reviewed the data collected, then inductively generated codes and themes based on the findings from the interviews. RESULTS: The focus group interviews revealed the following themes: unequal treatment, barriers to patient care, risk identifiers, support, and survivor recommendations. CONCLUSIONS: Youth survivors seeking healthcare reported multiple barriers based on their interaction with healthcare providers, such as the lack of provider awareness, education, training, feelings of shame, judgment, fear, racial biases, and lack of empathy. Improving patient outcomes relies on understanding the complexities of human trafficking and implementing an approach to decrease barriers to care. PRACTICE IMPLICATIONS: This study resulted in invaluable survivor recommendations with practical solutions on addressing human trafficking and exploitation in the healthcare system. The solutions proposed by participants included strengthening relationships and experiences with healthcare providers by increasing awareness, establishing rapport, creating a safe space, asking questions about their safety and situation, using a non-judgmental approach, and providing resources.

Identification and Incidence of Child Maltreatment During the COVID-19 Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has raised serious concerns about child maltreatment, which is known to increase in frequency and severity during times of high stress. The present study used diverse datasets to concurrently examine changes in identification and medical evaluation of maltreatment allegations from before to during COVID-19. Four sources of data were collected from two counties for the months of March-December in 2019 and 2020, including reports to social services and child maltreatment evaluation clinic medical evaluations (CMECs). The number of reports, number of children reported, and rate of children reported were used to evaluate identification. Incidence was estimated based on the number of medical evaluations conducted at the CMECs. Maltreatment type, reporter type, and child demographics were also considered. Across both counties, there were significantly fewer reports and reported children in 2020 compared to 2019, signifying decreased identification of suspected maltreatment cases. This was especially true in spring and fall when children are typically in school. Across both counties, the proportion of children reported to the county that received medical evaluations was higher in 2020 compared to 2019. This suggests that the pandemic was related to an increase in the occurrence maltreatment serious enough to warrant medical evaluations, or perhaps in the relative number of serious cases identified. Findings show divergent trends in reporting and evaluation of suspected maltreatment cases from before to during COVID-19. Identification and service delivery methods need creative solutions to adapt to changing environments. Medical, social, and legal systems need to prepare for increases in families seeking services as pandemic-related restrictions are lifted.

Multi-level prevention of human trafficking: The role of health care professionals.

As a major public health issue, human trafficking (HT) affects individuals, families, communities, and societies around the world. A public health approach to combating HT has been advocated. Such an approach seeks to prevent HT by engaging diverse stakeholder groups in addressing risk factors at multiple levels. As a key stakeholder group, health care professionals (HCPs) play a critical role in HT prevention. Herein, we use the Centers for Disease Control (CDC) Social-Ecological Model as a framework to present potential HT prevention strategies for health care professionals. As clinicians, HCPs may deliver tailored interventions to patients and families to address individual- and relationship-level risk factors for HT in the health care setting. As educators, advocates, and researchers, HCPs may collaborate across sectors to implement community- and society-level prevention strategies. Such strategies may include enhancing awareness of HT through education; advocating for local and national policies that promote community health and wellness; combating social or cultural norms that contribute to HT; and building a strong evidence-base to guide future HT prevention programs. Guided by the CDC Social-Ecological Model, we recommend that HCPs use their diverse skills to target risk factors for HT at multiple levels and thereby expand their impact in preventing this form of exploitation.