Labor and sex trafficking impact children of all ages, genders, and nationalities. Trafficked patients present to the emergency department for illnesses and injuries both related and unrelated to their trafficking experiences. Emergency clinicians are not meant to be experts in labor and sex trafficking, but they must know enough to be able to identify patients at risk for trafficking and ensure that these patients have the opportunity to be connected to relevant services and support. This issue reviews the ways in which youth are trafficked, the indicators of trafficking, and the evidence-based and best-practice recommendations for addressing suspected or confirmed trafficking in the pediatric and adolescent patient populations.
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2. “He’s here with his stepfather, who is a distinguished-looking gentleman. The ED is busy and it will take a while to do a one-on-one history. It’s only really necessary when the situation seems suspect.” Do not assume that a patient presenting in what appears to be a socially acceptable relationship is in a safe or healthy situation. Always speak with a patient privately at some point during their evaluation.
5. “Now that I know the indicators of a trafficking situation, I will be able to intervene and keep my patient safe. It feels good to rescue victims from scary situations.” Do not plan to “rescue” patients from a situation. The goal is to empower them to use their own agency to promote their health and wellbeing. If the patient is a minor and a mandated report is indicated, this should be done in a collaborative and trauma-informed manner.
8. “I want to avoid conflict, so I’m going to make this report to child welfare and not tell the patient.” Always inform a patient you are a mandated reporter before you gather sensitive information. If you see concerning indicators, make the mandated report in collaboration with the impacted youth, letting the patient know that you are a mandated reporter and that you are hoping to leverage helpful support for them. Do not make clandestine reports.
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Following are the most informative references cited in this paper, as determined by the authors.
1. * Institute of Medicine; National Research Council. Confronting Commercial Sexual Exploitation and Sex Trafficking of Minors in the United States: A Guide for Providers of Victim and Support Services. National Academies Press; 2014. (Organizational report)
2. * Greenbaum J, Bodrick N, Committee on Child Abuse and Neglect: Section on International Child Health. Global human trafficking and child victimization. Pediatrics. 2017;140(6):e20173138. (Policy statement) DOI: 10.1542/peds.2017-3138
7. * Chisolm-Straker M, Baldwin S, Gaïgbé-Togbé B, et al. Health care and human trafficking: we are seeing the unseen. J Health Care Poor Underserved. 2016;27(3):1220-1233. (Retrospective survey; 173 participants) DOI: 10.1353/hpu.2016.0131
40. * Macias-Konstantopoulos W, Zhou B. Physical health of human trafficking survivors: unmet essentials. In: Chisolm-Straker M, Stoklosa H, eds. Human Trafficking is a Public Health Issue: A Paradigm Expansion in the United States. Springer; 2017:185-210. (Textbook chapter)
52. * Shandro J, Chisolm-Straker M, Duber HC, et al. Human trafficking: a guide to identification and approach for the emergency physician. Ann Emerg Med. 2016;68(4):501-508.e501. (Review article) DOI: 10.1016/j.annemergmed.2016.03.049
72. * Greenbaum J, McClure RC, Stare S, et al. Documenting ICD Codes and Other Sensitive Information in Electronic Health Records. HEAL Trafficking; January 2021. Accessed June 1, 2022. (Documentation guidelines)
74. * CommonSpirit, HEAL Trafficking, Pacific Survivor Center. PEARR Tool: Trauma-Informed Approach to Victim Assistance in Health Care Settings. HEAL Trafficking; 2019. Accessed June 1, 2022. (Practice guideline)
98. * Macias-Konstantopoulos WL. Caring for the trafficked patient: ethical challenges and recommendations for health care professionals. AMA J Ethics. 2017;19(1):80-90. (Review article) DOI: 10.1001/journalofethics.2017.19.1.msoc2-1701
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Keywords: human trafficking, trafficking children, trafficking adolescents, trafficking teens, sex trafficking, labor trafficking, trauma-informed care, PEARR tool, CSE-IT, HEADS-ED, STIs, emergency contraception, consent, mandated reporting, trafficking response protocol
Lela Bachrach, MD, MS; Larissa Truschel, MD, MPH; Makini Chisolm-Straker, MD, MPH
Shannon Findlay, MD, MPH, CTropMed; Carmelle Wallace, MD, MPH, DTMH
July 1, 2022
July 1, 2025   CME Information