Confidential Screening for Sex Trafficking Among Minors in a Pediatric Emergency Department

Abstract

OBJECTIVES: Child sex trafficking is a global health problem, with a prevalence of 4% to 11% among high-risk adolescents. The objective of this study was to confidentially administer a validated screening tool in a pediatric emergency department by using an electronic tablet to identify minors at risk for sex trafficking. Our hypothesis was that this modality of administration would adequately identify high-risk patients. METHODS: English- and Spanish-speaking patients from the ages of 12 to 17 years presenting to a large urban pediatric emergency department with high-risk chief complaints were enrolled in a prospective cohort over 13 months. Subjects completed a previously validated 6-item screening tool on an electronic tablet. The screening tool’s sensitivity, specificity, and positive and negative predictive values were calculated. Multivariable logistic regression was performed to identify additional risk factors. RESULTS: A total of 212 subjects were enrolled (72.6% female; median age: 15 years; interquartile range 13–16), of which 26 patients were subjected to child sex trafficking (prevalence: 12.3%). The sensitivity and specificity of the electronic screening tool were 84.6% (95% confidence interval [CI] 70.8%–98.5%) and 53.2% (95% CI 46.1%–60.4%), respectively. The positive predictive value and negative predictive value were 20.2% (95% CI 12.7%–27.7%) and 96.1% (95% CI 92.4%–99.9%), respectively. A previous suicide attempt and history of child abuse increased the odds of trafficking independent of those who screened positive but did not improve sensitivity of the tool. CONCLUSIONS: A confidentially administered, previously validated, electronic screening tool was used to accurately identify sex trafficking among minors, suggesting that this modality of screening may be useful in busy clinical environments.

Sexual History Documentation and Screening in Adolescent Females with Suicidal Ideation in the Emergency Department

“…Hurst et al implemented a screening tool for sex trafficking in a pediatric ED and found a prevalence of 12% in high-risk patients. They identified that a history of child abuse and a prior suicide attempt increased the odds of trafficking [ 21 ]. We are likely missing an ideal opportunity to identify victims of trafficking in the pediatric ED, and screening must be improved.…”

Exploitation, Labor and Sex Trafficking of Children and Adolescents: Health Care Needs of Patients

“…Screening tools to identify people who may be experiencing T/E designed for a busy health care setting are emerging. 120,105,[121][122][123] The goal of a screen is not to obtain a patient's definitive disclosure of T/E but to determine which patients are at particularly high risk and what major factors may be contributing to that risk to inform medical intervention. For example, the Short Screen for Child Sex Trafficking 120,105,124 includes questions about risk factors (eg, substance use, involvement with law enforcement, number of sex partners, and history of STIs) rather than TABLE 2 Health Conditions Associated with Labor and Sex T/E 11,14-16,18-20, [47][48][49]52,59,98,120,146,[190][191][192][193][194][195][196][197] specific questions about T/E.…”

Human Trafficking

“…Providers often do not have sufficient suspicion of trafficking, 14,19,23 so providers may find it helpful to implement screening tools that give insight into high-risk behaviors that put patients at risk for trafficking. There are multiple screening tools available to evaluate for trafficking 24–26 . These tools are short, oriented toward patients who have sustained trauma from their trafficking experience and have good sensitivity for detecting trafficking victims.…”