A Survivor-Derived Approach to Addressing Trafficking in the Pediatric ED

Abstract

OBJECTIVES: Our objective was to elicit the perspectives of survivors of child trafficking on addressing trafficking in the pediatric emergency department (ED) and, secondarily, to provide a survivor-derived framework to help pediatric emergency medicine (PEM) providers discuss trafficking with their patients. METHODS: We conducted in-depth, semistructured interviews with young adults who experienced trafficking as children and/or as adolescents. In the interviews, we employed a novel video-elicitation method designed by the research team to elicit detailed participant feedback and recommendations on the pediatric ED through an interactive, immersive discussion with the interviewer. A grounded theory approach was employed. RESULTS: Seventeen interviews were conducted revealing the following themes, which we present in an integrated framework for PEM providers: (1) fear is a significant barrier; (2) participants do want PEM providers to ask about trafficking, and it is not harmful to do so; (3) PEM providers should address fear through emphasizing confidentiality and privacy and encouraging agency; (4) PEM providers should approach the patient in a direct, sensitive, and nonjudgmental manner; and (5) changes to the ED environment may facilitate the conversation. Suggested wordings and tips from survivors were compiled. CONCLUSIONS: Trafficking survivors feel that the pediatric ED can be a place where they can be asked about trafficking, and that when done in private, it is not harmful or retraumatizing. Fear is a major barrier to disclosure in the pediatric ED setting, and PEM providers can mitigate this by emphasizing privacy and confidentiality and increasing agency by providing choices. PEM providers should be direct, sensitive, and nonjudgmental in their approach to discussing trafficking.

The ethics and urgency of identifying domestic minor sex trafficking victims in clinical settings

“…When evaluating children and youth experiencing sex trafficking, liberty and agency are often compromised; victims face controlling influences, both from their traffickers and extreme environmental stress. 12,28 For typical pediatric procedures, medical ethics decisions are usually made by the parents. However, the situation may be different with children impacted by sex trafficking.…”

Validation of a screening tool for labor and sex trafficking among emergency department patients

“…Still, trafficking survivor–perspective literature demonstrates that patients appreciate when healthcare teams support their path to well‐being by directly engaging on this topic (rather than self‐administered surveys). 31 , 32 …”

“…Still, trafficking survivor-perspective literature demonstrates that patients appreciate when healthcare teams support their path to well-being by directly engaging on this topic (rather than selfadministered surveys). 31,32 Psychometric analysis demonstrates that the 4 RAFT questions perform well together, but the ideal administration is not yet known. As a 4-item screener, it takes about 2 minutes to administer, and optimal strategies for where, when, and by whom RAFT should be asked will vary in different EDs.…”

“…A patient may not feel comfortable telling their truth to the interviewer, may not have understood the questions, or the trafficking experience may not have been captured by RAFT. Still, trafficking survivor–perspective literature demonstrates that patients appreciate when healthcare teams support their path to well‐being by directly engaging on this topic (rather than self‐administered surveys) 31,32 …”

Screening for human trafficking in one emergency department: Social acceptance and practical dissonance

“…While concern was voiced about offending patients by asking questions about exploitation, the literature demonstrates that patients want to be asked. 8 Many patients recognize screening questions as standard and few people are upset when trained staff frame the questions appropriately with an introductory or normalizing statement. All the key informants in this investigation indicated the ED staff need more information and education about Nurse "There are a lot of questions that we have to answer in the primary [nursing assessment] so honestly, when we're busy, we just skip a lot of them, but the ones that have to be answered … .if it's in that grouping then that would definitely be something that would have to be answered."…”