Feasibility of a screening tool for sex trafficking in an adult emergency department

Abstract

Background: Human trafficking (HT) is a human rights violation and public health issue. People with a history of HT are likely to see a physician during their exploitation. A screening tool was developed and implemented in a busy urban emergency department (ED) to aid in the identification of this population. Objective:The objective was to retrospectively assess a HT screening tool implemented in an urban ED and evaluate the feasibility of the tool as a component of standard emergency care. Methods:This was a retrospective observational study conducted at an urban adult ED after the implementation of an original 11-item HT screening tool. Adult patients 18 years and older were screened based on high-risk chief complaints, "red flag" risk factors, or provider gestalt. All patients with a positive screen were offered the opportunity to speak to a social worker, who then determined the patients' likely trafficking status. Data analysis was performed on this group of patients.Results: A total of 26,974 patients were screened in the ED during 2019. Of these patients, 189 of them had a positive screen. A total of 37 patients were confirmed to have a likely sex trafficking status based on the federal definition. Eight of these patients elected to go to a community partner safe house. Positive responses to eight of the questions were significantly associated with likely sex trafficking status. Through regularized regression analysis, the predictive power of the screen was found to be derived from seven of the questions. Conclusion:Through the implementation of this screening tool, providers in a busy urban ED were able to identify patients with an experience of sex trafficking and offer them resources using a trauma-informed approach. This study demonstrates the feasibility of implementation of screening in the ED and identifies seven of the questions used as predictive of likely sex trafficking.

Prevalence estimates of trafficking in persons using statistical definitions: a cross-sectional high-risk community survey in Cape Town, South Africa

“…We examined the performance of TIP screeners using the receiver operating characteristics (ROC) analysis. 22 ROC combines sensitivity (positive predictive probability) and specificity (negative predictive probability), against the PRIF statistical definition criteria as ‘gold standards’. The values of the area under the curve (AUC) indicate how well each screener summary measure performed against the PRIF statistical definitions and usually indicates the model’s relative predictive value.…”

“…A unique aspect of this document is providing statistical rules that are akin to the to the Diagnostic and Statistical Manual of Mental Disorders approach 20. With many good human trafficking screening tools identified, some of which are rigorously evaluated,21 22 it is now feasible to apply select screeners to estimate the prevalence rates of TIP in a community using such statistical definitions.…”

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.…”

Emergency Medicine History and Expansion into the Future: A Narrative Review

“…Simple public-health interventions in the ED include the standard screening for depression, 18 domestic violence, 19 and sex and human trafficking. 20 The ED has for years attempted to reach individuals in need of immunization, 21 and now can play a key role in COVID-19 vaccination. 22 A 2009 EM publication called for more research, removal of barriers, innovation based on local needs, and legislation to improve incentives for large-scale community changes.…”