Identification and Treatment of Human Trafficking Victims in the Emergency Department: A Case Report

Gibbons, Patric; Stoklosa, Hanni

doi:10.1016/j.jemermed.2016.01.004

Cited by 49 publications

(57 citation statements)

References 13 publications

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“…Our rate of “true positive” screens was surprising, particularly given prior reports that victims are often reluctant to disclose their situations in healthcare settings 15. Victims fear discrimination from healthcare providers, reporting to legal authorities, and punishment from their traffickers 10,15. The number of victims identified during this brief pilot study suggests that our ED regularly cares for victims of sex trafficking.…”

Section: Discussionmentioning

confidence: 80%

“…This multidisciplinary approach to caring for victims of sex trafficking, including physicians, nurses, social workers and community groups, is important for providing the ongoing support that these victims require. 9,10…”

Section: Discussionmentioning

confidence: 99%

“…As there are no validated screening tools for sex trafficking in the ED, we assembled a 14-question screening survey based on published recommendations,10–13 which could be administered in 5–10 minutes during the ED visit. We pilot-tested this survey on 15 ED patients.…”

Section: Methodsmentioning

confidence: 99%

“…7–9 Several “red flags” and questions for providers to identify victims of sex trafficking in healthcare settings have been suggested10–13 but are not well studied in the ED. The feasibility of using these screening questions in the ED and their ability to identify victims of sex trafficking in the ED are unknown.…”

Section: Introductionmentioning

confidence: 99%

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Screening for Victims of Sex Trafficking in the Emergency Department: A Pilot Program

Mumma¹,

Scofield²,

Mendoza³

et al. 2017

WestJEM

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IntroductionEstimates suggest that hundreds of thousands of sex trafficking victims live in the United States. Several screening tools for healthcare professionals to identify sex trafficking victims have been proposed, but the effectiveness of these tools in the emergency department (ED) remains unclear. Our primary objective in this study was to evaluate the feasibility of a screening survey to identify adult victims of sex trafficking in the ED. We also compared the sensitivity of emergency physician concern and a screening survey for identifying sex trafficking victims in the ED and determined the most effective question(s) for identifying adult victims of sex trafficking.MethodsWe enrolled a convenience sample of medically stable female ED patients, age 18–40 years. Patients completed a 14-question survey. Physician concern for sex trafficking was documented prior to informing the physician of the survey results. A “yes” answer to any question or physician concern was considered a positive screen, and the patient was offered social work consultation. We defined a “true positive” as a patient admission for or social work documentation of sex trafficking. Demographic and clinical information were collected from the electronic medical record.ResultsWe enrolled 143 patients, and of those 39 (27%, 95% confidence interval [CI] [20%–35%]) screened positive, including 10 (25%, 95% CI [13%–41%]) ultimately identified as victims of sex trafficking. Sensitivity of the screening survey (100%, 95% CI [74%–100%]) was better than physician concern (40%, 95% CI [12%–74%]) for identifying victims of sex trafficking, difference 60%, 95% CI [30%–90%]. Physician specificity (91%, 95% CI [85%–95%]), however, was slightly better than the screening survey (78%, 95% CI [70%–85%]), difference 13%, 95% CI [4%–21%]. All 10 (100%, 95%CI [74%–100%]) “true positive” cases answered “yes” to the screening question regarding abuse.ConclusionIdentifying adult victims of sex trafficking in the ED is feasible. A screening survey appears to have greater sensitivity than physician concern, and a single screening question may be sufficient to identify all adult victims of sex trafficking in the ED.

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Screening for Victims of Sex Trafficking in the Emergency Department: A Pilot Program

Mumma¹,

Scofield²,

Mendoza³

et al. 2017

WestJEM

View full text Add to dashboard Cite

show abstract

“…Among individual practitioners, the greatest challenges to caring for this population are a lack of awareness of the prevalence of trafficking, an inability to identify victims of human trafficking, and a lack of appropriate communication techniques. Many victims are accompanied by their traffickers, who may fill out all paperwork and speak on behalf of the victim [9,17]. It is also important to note that victims will likely have a strong sense of fear or shame regarding their abuse and thus may not disclose even when the trafficker is not present [9].…”

Section: Challenges and Barriersmentioning

confidence: 99%

Taking Up the Mantle of Human Trafficking Education: Who Should Be Responsible?

Bohnert

Calhoun

Mittel

2017

AMA Journal of Ethics

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Human trafficking is a global human rights issue with long-range health consequences about which physicians are largely uneducated. Medical schools are uniquely positioned to address this gap. All future physicians, regardless of specialty, must learn to identify victims and refer them to trauma-informed treatment. Research and advocacy are needed to address the lack of rigorously evaluated curricula in this area, impact policy, and improve services for victims of this heinous form of exploitation. CaseIt's a busy summer night in the emergency department. You have seen 15 patients so far, and the fourth-year acting intern is approaching you with the sixteenth. He describes the patient as a young woman complaining of dysuria and increased urinary frequency whose history of present illness and physical exam are suggestive of cystitis. After discussing appropriate antibiotic and follow-up plans with the acting intern, you make your way to the bedside to confirm the student's findings. But before you can open the door the student stops you with additional concerns. "She seems younger than eighteen," he says, "and I get the feeling she wasn't telling me the truth about her social situation. I also noticed a few poor-quality tattoos that look homemade on physical exam. This made me suspicious, so I searched through her medical history. It looks like she's been here at least three times in the last several months for other complaints. She had a sexually transmitted infection (STI), a broken finger, and an eyebrow laceration. When I asked her about the injuries she was evasive and said she was clumsy. She seems sober now, but other physicians have noted that she was high on previous presentations. I may be way off base here, but I'm worried that she's being exploited. We learned about human trafficking last year, and this patient is showing several red flags."The student shows you some information online about the prevalence of human trafficking and its associated symptoms, and you decide to call the National Human

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