Objective The United States’ Institute of Medicine recommends that health care providers be aware of sex trafficking (ST) indicators and conduct risk assessments to identify people at risk. However, the challenges among those who conduct such assessments remain largely understudied. The aim of this study was to understand the perceived barriers to ST risk assessment among health care providers in a large health care organization. Methods This study used a collective case study approach in five sites of a large health care organization that serves high-risk populations in a Midwestern state. Twenty-three in-depth, semi-structured interviews were conducted with health care staff (e.g. medical assistants, nurse practitioners). Two research team members conducted independent deductive coding (e.g. knowledge of ST), and inductive coding to analyse emerging themes (e.g. responses to ST risk or commercial sex disclosures, provider role ambiguity). Results Although staff routinely screened by asking ‘Have you ever traded sex for money or drugs?’, participants primarily described avoiding further discussions of ST with adult patients because they (1) aimed to be non-judgmental, (2) viewed following up as someone else’s job, and/or (3) lacked confidence to address ST concerns themselves, particularly when differentiating sex work from ST. Differences all emerged based on clinical context (e.g. urban location). Conclusions There may be missed opportunities to assess patients for ST risk and use harm-reduction strategies or safety plan to address patients’ needs. Implications for practice, policy, and future research are discussed.

Aims:The aims of this study were to (1) explore the barriers and challenges of sex trafficking identification and (2) understand how sex trafficking indicators are perceived (i.e. relevance and utility) by healthcare providers at five sites of a large sexual health care organization in a Midwestern state within the United States.Design: A qualitative, collective case study was conducted. Method:In-depth, semi-structured interviews were conducted with 23 healthcare staff (e.g. medical assistants, nurse practitioners) who provided sexual and reproductive healthcare between fall 2018 and spring 2020.Results: Findings suggest that providers perceived behavioural and verbal sex trafficking indicators (e.g. patients appearing nervous or being unable to answer questions) as relevant, particularly with a female patient accompanied by a 'controlling' male. Medical and physical indicators (e.g. repeat STIs, bruises and tattoos) were perceived as generally lacking clinical utility or irrelevant. Some indicators were only perceived as relevant when combined or only later, upon reflection (e.g. older, female adult accompanying one or more female patients). Conclusion:Healthcare providers may be aware of sex trafficking indicators conducive to identifying female patients, in relationships with older men, who are at risk of sex trafficking. Our study finds that healthcare providers may not be aware of all recommended sex trafficking indicators and the nuances of how patients present.Impact: Provider trainings on sex trafficking dynamics and nuanced clinical presentations should include observing ST indicators in simulated interviews, assessing and safety planning (including using harm reduction strategies) with seemingly ambiguous cases. In addition, we recommend that trainings emphasize the relationship between the continuum of agency and victimization in sex trafficking and patient presentations.

Despite growing evidence suggesting that LGBTQ+ people are at risk of sex trafficking (ST), the ways in which social service providers encounter and address this population remain understudied. This study uses a directed content analysis approach to understand providers’ perceived knowledge of and practice with LGBTQ+ people at risk of ST. Authors conducted 24 semistructured, in-depth interviews of social service providers who worked with people who were sex trafficked (predominantly youth and young adults) in a region of a midwestern state. Providers had a range of knowledge and practice strategies, which included using outdated LGBTQ+ terminology and problematic assumptions about ST risk among LGBTQ+ individuals and also about how experiences of trauma influenced LGBTQ+ people’s sexuality and gender. Those who did encounter LGBTQ+ people at risk of ST suggested that there were gaps in services, particularly for trans clients. In addition, providers’ knowledge and practice strategies generally reflected an outdated understanding of gender and sexuality as stagnant and binary. Social service providers have an important opportunity to provide inclusive and affirming services to LGBTQ+ people at risk of ST. The article concludes with a discussion of the implications for practice (e.g., language recommendations and provider trainings), organizations, and future research.

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