Atkinson G, Curnin KJ, Hanson NC. US state laws addressing human trafficking: Education of and mandatory reporting by health care providers and other professionals. Journal of Human Trafficking. 2016; 2 (2) : 111-138.
Human trafficking is a global problem and constitutes a grave human rights …
Human trafficking is a global problem and constitutes a grave human rights violation, affecting more than 20 million individuals worldwide. This brutal crime often results in both short- and long-term physical and psychological harm to its victims. We provide a systematic review of U.S. laws that address education about human trafficking and/or mandatory reporting requirements that affect healthcare providers and other professionals across the United States. Thirteen U.S. states now have laws that address education about human trafficking, while seven specifically require mandatory reporting of minors who are victims of trafficking. The findings are instructive to not only practicing physicians and other professionals, who are now mandated reporters of trafficking victims in some states, but also to regulatory and legislative bodies contemplating enacting such laws in an effort to address trafficking.
Beck ME, Lineer MM, Melzer-Lange M, Simpson P, Nugent M, Rabbitt A. Medical providers' understanding of sex trafficking and their experience withat-risk patients.. Pediatrics. 2015; 135 (4) : e895-902.
Keywords: *Attitude of Health Personnel, *Awareness, Child, *Comprehension, Data Collection, Female, Human Trafficking, Humans, Inservice Training, Male, *Patient Care Team, Pediatrics/*education, Risk Assessment, Software, Surveys and Questionnaires, Wisconsin
BACKGROUND AND OBJECTIVES: Sex trafficking (ST) victims have unique medical …
BACKGROUND AND OBJECTIVES: Sex trafficking (ST) victims have unique medical andmental health needs and are often difficult to identify. Our objectives were toevaluate knowledge gaps and training needs of medical providers, to demonstratethe importance of provider training to meet the pediatric ST victim's specificneeds, and to highlight barriers to the identification of and response tovictims. METHODS: A survey was sent to providers in specialties that would bemost likely to encounter victims of ST. Participants included physicians, nurses,physician assistants, social workers, and patient and family advocates atmultiple hospitals and medical clinics in urban, suburban, and rural locations.RESULTS: Of ∼ 500 survey recipients, 168 participants responded. In 2 clinicalvignettes, 48% correctly classified a minor as an ST victim, and 42% correctlydistinguished an ST victim from a child abuse victim. In all, 63% of respondentssaid that they had never received training on how to identify ST victims. Thosewith training were more likely to report ST as a major problem locally (P ≤.001), to have encountered a victim in their practice (P ≤ .001), and to havegreater confidence in their ability to identify victims (P ≤ .001). The greatestbarriers to identification of victims reported were a lack of training (34%) andawareness (22%) of ST. CONCLUSIONS: Health care providers demonstrate gaps inknowledge and awareness of ST, specifically of pediatric victims, that correlatewith their limited experience and training. Training is crucial to improveidentification of these victims and provide appropriate care for their specificneeds.
Clawson HJ, Dutch N, Solomon A, Goldblatt Grace L. Human trafficking into and within the United States: A review of the literature. Study of HHS Programs Serving Human Trafficking Victims.. 2009..
This comprehensive review of current literature on human trafficking into and …
This comprehensive review of current literature on human trafficking into and within the United States focuses on surveying what the social science or other literature has found about the issues of identifying and effectively serving trafficking victims. A more specific focus concerns the phenomenon of domestic trafficking (trafficking involving U.S. citizens or lawful permanent residents, often within the U.S.), the impact on domestic youth, and the availability and/or effectiveness of services for these victims.
Edwards JM, Iritani BJ, Hallfors DD. Prevalence and correlates of exchanging sex for drugs or money among adolescentsin the United States.. Sexually Transmitted Infections. 2006; 82 (5) : 354-8.
Keywords: Adolescent, Female, Humans, Male, Prognosis, Sex Work/*statistics & numerical data, Socioeconomic Factors, Substance-Related Disorders/epidemiology, United States/epidemiology, Unsafe Sex/statistics & numerical data
OBJECTIVE: This study examined the prevalence and correlates of exchanging …
OBJECTIVE: This study examined the prevalence and correlates of exchanging sexfor drugs or money among a nationally representative sample of 13,294 adolescentsin the United States. METHODS: Data are from the National Longitudinal Study ofAdolescent Health, waves I and II. The lifetime prevalence of exchanging sex wasestimated and a cross sectional analysis of sociodemographic and behaviouralcorrelates was conducted. Unadjusted odds ratios were obtained. RESULTS: 3.5% ofadolescents had ever exchanged sex for drugs or money. Two thirds of these youthswere boys. The odds of having exchanged sex were higher for youths who had useddrugs, had run away from home, were depressed, and had engaged in various sexualrisk behaviours. 15% of boys and 20% of girls who had exchanged sex reported theyhad ever been told they have HIV or another sexually transmitted infection (STI).CONCLUSIONS: Adolescents with a history of exchanging sex have engaged in otherhigh risk behaviours and may experience poor health outcomes, includingdepression and HIV/STIs. These findings should help inform strategies to preventthis high risk sexual behaviour and its potential consequences.
English A. Mandatory Reporting of Human Trafficking: Potential Benefits and Risks of Harm.. AMA Journal of Ethics. 2017; 19 (1) : 54-62.
Keywords: Crime Victims, Delivery of Health Care, Ethics, Clinical, Health Personnel, *Human Trafficking/prevention & control, Humans, *Mandatory Reporting, *Patient Acceptance of Health Care, Professional-Patient Relations, Risk Assessment, Survivors, *Trust
Human trafficking, including both sex and labor trafficking, has …
Human trafficking, including both sex and labor trafficking, has profoundconsequences for the safety, health, and well-being of victims and survivors.Efforts to address human trafficking through prevention, protection, andprosecution are growing but remain insufficient. Mandatory reporting has thepotential to bring victims and survivors to the attention of social service andlaw enforcement agencies but may discourage trafficked persons from seeking help,thereby limiting the ability of health care professionals to establish trust andprovide needed care. States' experience in implementing child abuse laws can beuseful in assessing the potential risks and benefits of mandatory reporting ofhuman trafficking.
Goldberg AP, Moore JL, Houck C, Kaplan DM, Barron CE. Domestic Minor Sex Trafficking Patients: A Retrospective Analysis of MedicalPresentation.. Journal of Pediatric and Adolescent Gynecology. 2017; 30 (1) : 109-115.
Keywords: Adolescent, *Attitude of Health Personnel, Awareness, Child, Child Abuse, Sexual/*diagnosis/psychology, Emergency Service, Hospital, Female, *Health Knowledge, Attitudes, Practice, Homeless Youth/psychology, Hospitals, Pediatric, Human Trafficking/*psycho
STUDY OBJECTIVE: To describe the clinical characteristics of patients …
STUDY OBJECTIVE: To describe the clinical characteristics of patients referredfor domestic minor sex trafficking (DMST) to improve identification andintervention. DESIGN: Retrospective cohort study. SETTING: The Lawrence A. Aubin,Sr Child Protection Center at Hasbro Children's Hospital where patients areevaluated by child abuse pediatricians in outpatient, emergency department, andinpatient settings. PARTICIPANTS: A total of 41 patients younger than the age of18 years referred for the evaluation of DMST involvement between August 1, 2013and March 30, 2015. INTERVENTIONS AND MAIN OUTCOME MEASURES: We collecteddemographic, social-environmental, medical, and psychiatric variables from themedical records of patients referred for evaluation who have self-disclosed, beenreported with evidence, and/or have histories that place them at high risk forDMST involvement. RESULTS: Children had frequent contact with medical providers,with 81% seen in the year before referral for DMST. Childhood maltreatment andfamily dysfunction were identified (sexual abuse, 21/37 or 57%; parentalsubstance abuse, 22/37 or 60%) in the 41 patients. Children had medical problems(eg, sexually transmitted infection, 13/41 or 32%), psychiatric needs (eg, acutesuicidality, 8/41 or 20%; at least 1 previous psychiatric admission, 19/41 or46%), and substance use (36/41 or 88%). Although 26/41 (63%) had runaway and17/41 (42%) lived in a group home placement, 28/41 (68%) currently lived at homeand 29/41 (71%) presented with a parent/guardian or relative. CONCLUSION:Children referred for DMST present frequently to physicians and have complexmedical and psychiatric needs. Medical providers' increased awareness of thishealth issue would inform victim identification and intervention.
Greenbaum J et al, APSAC Working Group. The Commercial Sexual Exploitation of Children: The Medical Provider’s Role in Identification. 2013..
The commercial sexual exploitation of children (CSEC) is a major public health …
The commercial sexual exploitation of children (CSEC) is a major public health problem in the United States and worldwide. Although the true prevalence of CSEC is unknown, it has been estimated that approximately 244,000 U.S. children are at risk for commercial sexual exploitation each year (Estes & Weiner, 2002). In a recent study, Edwards and colleagues found that among a nationally representative sample of more than 13,000 U.S. adolescents, 3.5% admitted to exchanging sex for money or drugs (Edwards, Iritani, & Hallfors, 2006). Many CSEC victims will present for medical care at some point during their period of exploitation, often for treatment of acute conditions. These guidelines provide medical professionals with an overview regarding the current understanding of the commercial sexual exploitation of children. They focus on the epidemiology of CSEC, the impact of exploitation on victim physical and mental health, and the role of the medical provider in identifying victims, assessing their needs and securing appropriate services. The guidelines primarily address the needs of victims of prostitution and other sexually oriented work (for example, exotic dancing) and sex tourism; the needs of victims of pornography are described in detail elsewhere (Cooper, 2005a).
Greenbaum J, Bodrick N, AAP COMMITTEE ON CHILD ABUSE AND NEGLECT, AAP SECTION ON INTERNATIONAL CHILD HEALTH. Global human trafficking and child victimization.. Pediatrics. 2017; 140 (6).
Keywords: education, medical, human trafficking, labor, victimization, public policy, sex trafficking, statutes and laws
Trafficking of children for labor and sexual exploitation violates basic human …
Trafficking of children for labor and sexual exploitation violates basic human rights and constitutes a major global public health problem. Pediatricians and other health care professionals may encounter victims who present with infections, injuries, posttraumatic stress disorder, suicidality, or a variety of other physical or behavioral health conditions. Preventing child trafficking, recognizing victimization, and intervening appropriately require a public health approach that incorporates rigorous research on the risk factors, health impact, and effective treatment options for child exploitation as well as implementation and evaluation of primary prevention programs. Health care professionals need training to recognize possible signs of exploitation and to intervene appropriately. They need to adopt a multidisciplinary, outward-focused approach to service provision, working with nonmedical professionals in the community to assist victims. Pediatricians also need to advocate for legislation and policies that promote child rights and victim services as well as those that address the social determinants of health, which influence the vulnerability to human trafficking. This policy statement outlines major issues regarding public policy, medical education, research, and collaboration in the area of child labor and sex trafficking and provides recommendations for future work.
Greenbaum J, Crawford-Jakubiak JE. Child sex trafficking and commercial sexual exploitation: health care needs ofvictims.. Pediatrics. 2015; 135 (3) : 566-74.
Keywords: Child, Child Abuse, Sexual/*legislation & jurisprudence/statistics & numerical data, Health Services Needs and Demand/*legislation & jurisprudence, Human Trafficking/*legislation & jurisprudence, Humans, *Public Health, Sexual Behavior, United States
Child sex trafficking and commercial sexual exploitation of children (CSEC) …
Child sex trafficking and commercial sexual exploitation of children (CSEC) aremajor public health problems in the United States and throughout the world.Despite large numbers of American and foreign youth affected and a plethora ofserious physical and mental health problems associated with CSEC, there islimited information available to pediatricians regarding the nature and scope ofhuman trafficking and how pediatricians and other health care providers may helpprotect children. Knowledge of risk factors, recruitment practices, possibleindicators of CSEC, and common medical and behavioral health problems experiencedby victims will help pediatricians recognize potential victims and respondappropriately. As health care providers, educators, and leaders in childadvocacy, pediatricians play an essential role in addressing the public healthissues faced by child victims of CSEC. Their roles can include working toincrease recognition of CSEC, providing direct care and anticipatory guidancerelated to CSEC, engaging in collaborative efforts with medical and nonmedicalcolleagues to provide for the complex needs of youth, and educating child-servingprofessionals and the public.
Greenbaum VJ, Dodd M, McCracken C. A Short Screening Tool to Identify Victims of Child Sex Trafficking in the HealthCare Setting.. Pediatric Emergency Care. 2018; 34 (1) : 33-37.
Keywords: Adolescent, Child, Child Abuse, Sexual/*diagnosis/statistics & numerical data, Child Welfare, Crime Victims/*statistics & numerical data, Cross-Sectional Studies, Emergency Service, Hospital, Female, Human Trafficking/*statistics & numerical data, Humans,
OBJECTIVES: The aim of this study was to describe characteristics of …
OBJECTIVES: The aim of this study was to describe characteristics of commercialsexual exploitation of children/child sex trafficking (CSEC/CST) victims and todevelop a screening tool to identify victims among a high-risk adolescentpopulation. METHODS: In this cross-sectional study, patients aged 12 to 18 yearswho presented to 1 of 3 metropolitan pediatric emergency departments or 1 childprotection clinic and who were identified as victims of CSEC/CST were comparedwith similar-aged patients with allegations of acute sexual assault/sexual abuse(ASA) without evidence of CSEC/CST. The 2 groups were compared on variablesrelated to medical and reproductive history, high-risk behavior, mental healthsymptoms, and injury history. After univariate analysis, a subset of candidatevariables was subjected to multivariable logistic regression to identify anoptimum set of 5 to 7 screening items. RESULTS: Of 108 study participants, 25comprised the CSEC/CST group, and 83 comprised the ASA group. Average (SD) agewas 15.4 (1.8) years for CSEC/CST patients and 14.8 (1.6) years for ASA patients;100% of the CSEC/CST and 95% of the ASA patients were female. The 2 groupsdiffered significantly on 16 variables involving reproductive history, high-riskbehavior, sexually transmitted infections, and previous experience with violence.A 6-item screen was constructed, and a cutoff score of 2 positive answers had asensitivity of 92%, specificity of 73%, positive predictive value of 51%, andnegative predictive value of 97%. CONCLUSIONS: Adolescent CSEC/CST victims differfrom ASA victims without evidence of CSEC/CST across several domains. A 6-itemscreen effectively identifies CSEC/CST victims in a high-risk adolescentpopulation.
Institute of Medicine; National Research Council. Confronting Commercial Sexual Exploitation and Sex Trafficking of Minors in theUnited States: A Guide for Providers of Victim and Support Services. 2014..
Commercial sexual exploitation and sex trafficking of minors in the United …
Commercial sexual exploitation and sex trafficking of minors in the United Statesare frequently overlooked, misunderstood, and unaddressed domestic problems. Inthe past decade, they have received increasing attention from advocates, themedia, academics, and policy makers. However, much of this attention has focusedinternationally. This international focus has overshadowed the reality thatcommercial sexual exploitation and sex trafficking of minors also occur every daywithin the United States. Commercial sexual exploitation and sex trafficking ofminors not only are illegal activities, but also result in immediate andlong-term physical, mental, and emotional harm to victims and survivors. A nationthat is unaware of these problems or disengaged from solving them unwittinglycontributes to the ongoing abuse of minors and all but ensures that these crimeswill remain marginalized and misunderstood. The 2013 Institute of Medicine andthe National Research Council report Confronting Commercial Sexual Exploitationand Sex Trafficking of Minors in the United States increases awareness andunderstanding of the crucial problem of commercial sexual exploitation and sextrafficking of minors in the United States. By examining emerging strategies forpreventing and identifying these crimes, for assisting and supporting victims andsurvivors, and for addressing exploiters and traffickers, that report offers apath forward through recommendations designed to increase awareness andunderstanding and to support efforts to prevent, identify, and respond to thesecrimes. Confronting Commercial Sexual Exploitation and Sex Trafficking of Minorsin the United States: A Guide for Providers of Victim and Support Services offersa more concise and focused perspective on the problem and emerging solutions forproviders of victim and support services for children and adolescents. Theseservice providers include policy makers, leaders, practitioners, organizations,and programs at the local, state, and federal levels. This guide will be avaluable resource for them, and for child welfare and child protective services,other agencies and programs within the state and federal governments (e.g., theU.S. Department of Justice's Office for Victims of Crime), and nongovernmentalorganizations.
Kaplan DM, Moore JL, Barron CE, Goldberg AP. Domestic Minor Sex Trafficking: Medical Follow-up for Victimized and High-Risk Youth.. Rhode Island Medical Journal (2013). 2018; 101 (4) : 25-27.
Keywords: Adolescent, Child, Child Abuse, Sexual/psychology/*therapy, Crime Victims/*psychology, Female, Follow-Up Studies, Human Trafficking/psychology/*statistics & numerical data, Humans, Male, Physical Examination, *Practice Guidelines as Topic, Sexually Transm
Domestic minor sex trafficking (DMST) has become an increasingly recognized …
Domestic minor sex trafficking (DMST) has become an increasingly recognized issueassociated with both immediate and long-term physical and mental healthconsequences. Guidelines have focused on potential risk factors, recruitmentpractices, and health consequences for these youth assisting in identificationand intervention efforts. However, recommendations have not been established forcontinuous medical intervention and follow-up for this vulnerable patientpopulation that includes both patients involved in and at high risk for DMST. Ourgoal is to highlight preliminary recommendations for and the importance ofmedical visits for these youth. A comprehensive physical examination, STI testingand treatment, and pregnancy prevention options are important to address thepatients' concerns for their body and identify acute and chronic injuries.Further, collaborating with other medical and non-medical providers can provideessential resources for the multifaceted needs of DMST patients.
Moore JL, Baird G, Goldberg AP. Sex Trafficking Assessment and Resources (STAR) for Pediatric Attendings in Rhode Island. Rhode Island Medical Journal (2013). 2016; 99 (9) : 27-30.
Keywords: commercial sexual exploitation of children,domestic minor sex trafficking,training,victim
BACKGROUND: Domestic minor sex trafficking (DMST) victims have unique medical …
BACKGROUND: Domestic minor sex trafficking (DMST) victims have unique medical and mental health needs and present frequently for medical attention. Little is known about the reported training, screening, comfort and knowledge of DMST among pediatricians in Rhode Island who likely encounter these patient victims without knowing. METHODS: An anonymous electronic survey sent to Rhode Island Hospital staff physicians from November 2014 through January 2015. RESULTS: Of the 109 participants, the majority reported no training, screened no patients for DMST in the past year, did not know any resources available and had limited knowledge and comfort with this pediatric patient population. CONCLUSIONS: Rhode Island pediatricians of various specialties do not feel adequately prepared to identify and respond to a DMST patient population. These findings inform the need for increased training and education on DMST in our medical community. [Full article available at http://rimed.org/rimedicaljournal-2016-09.asp, free with no login].
Powell C, Dickins K, Stoklosa H. Training US health care professionals on human trafficking: where do we go fromhere?. Medical Education Online. 2017; 22 (1) : 1267980.
Keywords: Education, Medical, Continuing/organization & administration, Emergency Service, Hospital, Health Personnel/*education, Hotlines, *Human Trafficking, Humans, Inservice Training/*organization & administration, Interviews as Topic
Some 21 million adults and children are labor-trafficked or sex-traffickedthroug …
Some 21 million adults and children are labor-trafficked or sex-traffickedthrough force, fraud, or coercion. In recognition of the interface betweentrafficking victims and the healthcare setting, over the last 10 years there hasbeen a notable increase in training of health care professionals (HCPs) on humantrafficking (HT) and its health implications. Many organizations have developedcurricula and offered training in various clinical settings. However, methods andcontent of this education on trafficking vary widely, and there is littleevaluation of the impact of the training. The goal of this study was to assessthe gaps and strengths in HT education of HCPs in the US. This mixed-method studyhad two components. The first component consisted of structured interviews withexperts in human trafficking HCP education. The second portion of the studyinvolved an analysis of data from HCP calls to the National Human TraffickingResource Center (NHTRC). The interviews captured trainer-specific data on typesof HT training, duration and frequency, key content areas, presence of evaluationapproaches and indicators, as well as an assessment of barriers and strengths inHT training for HCP. NHTRC call database analysis demonstrated increasing trendssince 2008 in calls by HCPs. Overall findings revealed the need forstandardization of HT training content to assure correct information,trauma-informed and patient-centered care, and consistent messaging for HCPs.Evaluation metrics for HT training need to be developed to demonstrate behaviorchange and impact on service delivery and patient-centered outcomes for HTvictims, according to our proposed adapted Kirkpatrick's Pyramid model. HTtraining and evaluation would benefit from an agency or institution at thenational level to provide consistency and standardization of HT training contentas well as to guide a process that would develop metrics for evaluation and thebuilding of an evidence base. ABBREVIATIONS: AAP: American Academy of Pediatrics;ACF: Administration for Children and Families; CME: Continuing medical education;ED: Emergency department; HCP: Health care professional; HEAL: Health, Education,Advocacy, and Linkage; HHS: United States Department of Health and HumanServices; HT: Human trafficking; IOM: United States Institute of Medicine; MH:Mental health; NHTRC: National Human Trafficking Resource Center; SOAR: Stop,Observe, Ask, and Respond to Health and Wellness Training.
Recknor FH, Gemeinhardt G, Selwyn BJ. Health-care provider challenges to the identification of human trafficking in health-care settings: . Journal of Human Trafficking. 2018; 4 (3).
Keywords: health-care provider, human trafficking, identification challenges
This study explored health-care providers’ perspectives on practitioner-relate …
This study explored health-care providers’ perspectives on practitioner-related factors that can challenge their ability to identify adult victims of labor and sex trafficking seeking medical attention in the U.S. health-care system. Forty-four interviews were conducted with health-care professionals in Houston, Texas, between June 2015 and February 2016. Thematic content analysis was conducted to identify emerging themes. Overall, the number of victims identified by providers was low as was providers’ awareness and knowledge of human trafficking, particularly forced labor. Clinician-related factors inhibiting identification included the following: inadequate community resources for which to refer victims and clinician lack of knowledge of extant resources; the absence of institutional guidance in caring for victims; and clinician-held stereotypes of stigmatized populations. Findings of this study provide support for existing scholarship. They also suggest that health-care settings need to implement protocols for care with mechanisms of referral to vetted community resources for victims who decide to leave their traffickers. Findings also suggest the need for evidenced-based education for health-care providers, which address stereotypes that can impede provider/patient relations. Trainings might draw on established best practices for working with other stigmatized populations such as those with HIV and mental illness.
Stoklosa H, Showalter E, Melnick A, Rothman EF. Health care providers' experience with a protocol for the identification, treatment, and referral of human-trafficking victims.. Journal of Human Trafficking. n.d.; 3 (3) : 182-192.
Keywords: Exploitation, health care protocol, human trafficking, trauma-informed care, violence victims
The health care setting is thought to be one of the most promising places to …
The health care setting is thought to be one of the most promising places to identify victims of human trafficking. The present study was designed to relay the experiences of a sample of 10 health care providers and hospital administrators who developed and have used a protocol to identify victims of human trafficking since February 2014. To our knowledge, the protocol was one of the first to be adopted by any health care system in the United States. Three primary themes emerged from the participant interviews. First, developing the protocol was challenging because, at the time, there were no predecessor examples. Second, providers reported that the protocol is simple to use and victim identification is easier because of it. Third, identifying and serving victims of human trafficking remains challenging, because there is still a deficit of trained providers and a lack of community resources for survivors. The field needs evidence that this and similar protocols improve users’ knowledge and skills, result in the better identification and treatment of trafficking victims and ultimately improve public safety and public health.
