Evaluation of a Screening Tool for Child Sex Trafficking Among Patients With High‐Risk Chief Complaints in a Pediatric Emergency Department

Abstract

ObjectivesThe objective was to apply and evaluate a screening tool to identify victims of child sex trafficking (CST) in a pediatric emergency department (PED) population.MethodsThis prospective, observational study was conducted from July 2017 to November 2017 at the PED of a free‐standing, inner‐city children's hospital. Patients 10 to 18 years of age presenting with chief complaints related to high‐risk social or sexual behaviors were recruited in a representative convenience sampling. A previously developed six‐item screening tool was administered verbally to participants. A positive screen was defined as two positive answers from the six items. A patient was considered a “true” CST victim if any information obtained during the visit indicated that their circumstances fulfilled the federal definition of CST. Descriptive statistics were calculated for all variables of interest. CST screening tool analysis included sensitivity, specificity, and positive and negative predictive values (PPV, NPV). Those patients identified as positive for CST were referred to social services and received the current standard of care.ResultsA total of 254 patients met chief complaint screening criteria and eligibility; 215 were approached to participate and 203 agreed to participate. Of the 203 participants, 100 screened positive with the tool (49%). The total number of CST victims identified was 11 (5.4%), 10 of whom screened positive. With a cutoff score of two positive answers the tool demonstrated a 90.9% (95% confidence interval [CI] = 58.7%–99.8%) sensitivity, 53.1% (95% CI = 45.6%–60.4%) specificity, 10.0% (95% CI = 5.0%–17.6%) PPV, and 99.0% (95% CI = 94.7%–99.9%) NPV.ConclusionsApplied to an inner‐city PED population of 203 participants with high‐risk chief complaints, the screening tool has high sensitivity and high NPV. This makes it appropriate for an initial screening to rule out CST in this high‐risk population. Applicability for broader use and additional practice settings are warranted given the significant positivity rate among those presenting with high‐risk concerns.

Identifying children exposed to maltreatment: a systematic review update

“…The authors found that "no instrument had adequate levels of evidence for all criteria, and no criteria were met by all instruments" [64]. Our review also resulted in similar findings to the original review by Bailhache et al [13], in that 1) most studies did not report sufficient information to judge all criteria in the risk of bias tool; 2) most studies did not clearly blind the analysis of the reference standard from the index test (or the reverse); 3) some studies [26,36,37,39] included the index test as part of the reference standard (incorporation bias), which can overestimate the accuracy of the index test; and 4) some studies used a case-control design [29,31,36], which can overestimate the performance of the index test. A particular challenge, also noted by Bailhache et al [13], was the quality of reporting in many of the included studies.…”

“…1). From this set of results, 93 full-text articles were reviewed for inclusion, of which 19 new articles (representing 18 studies) were included [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]. In addition, the 13 studies evaluated in the Bailhache et al review [43][44][45][46][47][48][49][50][51][52][53][54][55] were included in this review update, for a total of 32 articles (31 studies).…”

“…Three studies [36,37,39] reported on use of a 6-item screening questionnaire for child sex trafficking, where an answer to two or more questions (e.g., Has the youth ever run away from home?) indicated suspicion of a child being exposed to sex trafficking.…”

“…indicated suspicion of a child being exposed to sex trafficking. The studies tested the screening questionnaire in children of a similar age group (10,11, or 12 to 18 years of age) presenting to emergency departments [36,37,39], child advocacy centres or teen clinics [37].…”

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

“…Multiple healthcare institutions and organizations have developed trafficking screening tools, 9 , 10 yet only the Child Sex Trafficking Screening Tool is validated for healthcare settings and it is explicitly for sex trafficking screening of adolescents presenting with specific chief complaints. 11 The social, and, in some states, legislative pressure to identify trafficking has led institutions to use unvalidated trafficking screening tools. 12 , 13 Unvalidated tools lack sensitivity and specificity with the potential to negatively impact individual patient care and ultimately public health data collection.…”