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Sex Trafficking in the ED: Identification, Documentation, and Intervention

Learn about the risk factors, screening tools, and methods of documenting and intervening in cases of sex trafficking in the emergency department. Protect vulnerable patients and provide necessary medical interventions while ensuring safety for all.

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Sex Trafficking in the ED: Identification, Documentation, and Intervention

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  1. Case: ED CC: Abdominal pain, dysuria PMHx: None PSHx: None At a glance: 15y F, no past ED visits in EMR, accompanied by dad, appears withdrawn

  2. Case #1: SGAH ED • How deep do you need to go into investigating her mood? • What if dad refuses to leave room during the exam? • What if the man in the room isn’t the father?

  3. Sex Trafficking in the ED Patrick Finan, MD PGY-2 Georgetown Emergency Medicine

  4. Roadmap • Case • Who is at risk • What can we do • UC Davis Screening Tool • How do we document • Who to contact

  5. Who? In 2014, the Urban Institute studied the underground commercial sex economy in 8 U.S. cities and estimated that this illicit activity ranged from $39.9 million and $290 million in revenue According to the study, pimps in one city earned an average of $32,833 per week.

  6. Who?

  7. Who?

  8. Who?

  9. But how? • Financial instability: sustained unemployment, unpaid debts, and desperation • Chronic homelessness/lack of stable housing • Substance abuse • Complex relationships These are the people we should be screening.

  10. How are we finding them?

  11. UC Davis Screening Tool Who: Convenience sample of medically stable female ED patients (age range 18-40) How: 14-question survey + Physician Concern What: “yes” to any question = social work consultation “true positive”: admission for/documentation of sex trafficking

  12. UC Davis Screening Tool 143 patients enrolled 58% non-white (demographics of surrounding area 64% white, 23% Hispanic/Latino) Exclusion Criteria: <18yo Prisoners/those in custody Unable to read/understand English or Spanish

  13. UC Davis Screening Study • Out of 143 women, 46 patients screened positive for possible sex trafficking • 30 (21%) on the screening survey only • 7 (7%) on physician concern only • 9 on both 10 patients were confirmed victims, none on physician concern alone. Majority (80%) had visited the ED within the past 2 years while only 1 had been to a clinic within the hospitals health system

  14. UC Davis Screening Study • Sensitivity of screening study was better than physician concern (100% vs 40%) • Why are we missing these? • “were you/someone you worked with ever beaten, hit, yelled at, raped, threatened or made to feel physician pain for working slowly or for trying to leave”: 100% yes rate among the victims • Stand-alone question?

  15. Specifically, kids • Risk Factors • Children who are chronically missing or who frequently run away (especially 3+ missing incidents) • Children who have experienced childhood sexual abuse, sexual assault/rape • Experience with or exposure to substance abuse • Children who identify as LGBTQ (homelessness/stigmatization)

  16. Specifically, kids • Behavioral Indicators • significant change in behavior/sudden change in group of friends • avoids answering questions, looks to others or lets others speak for him or her • appears frightened, resistant, or belligerent to law enforcement  • lies about his or her age and identity • Reference traveling job opportunities

  17. Specifically, kids • Physical Indicators • multiple cell phone, large amounts of cash/CC, no ID • excessive travel to other locations, not from current location, lack knowledge of travel plans • appearance doesn’t match current situation

  18. How do we document? • History • medically relevant facts/supporting details -> avoids disputes in legal cases • Patients own words in quotation marks • PE • old scars, surgical incisions, birthmarks, lesions, tattoos, piercings (photographs? Drawings?) • Assessment/Plan • “not c/w history” • care with assessing age of bruising • “suspected human trafficking” – even if pt denies

  19. Who do we tell? Do we tell? • First and foremost: do no harm • the safety of the trafficked person, the ED staff, and other patients-> esp if trafficker is there • Provide necessary medical interventions for patients before addressing the possibility of/need for law enforcement involvement. • Consider Law Enforcement if: • state-specific mandated reporting scenarios • patient request • imminent danger to staff or the patient(s) • Suspected or confirmed? Call the NHTRC hotline (1-888-373-7888). They can help provide shelter, legal services, and law enforcement assistance • Information about human trafficking can also be displayed in the ED. (restrooms, small itemslike pens, matchboxes, and soap w/ resource numbers.

  20. Jot these down

  21. Questions?

  22. References • http://www.missingkids.com/theissues/trafficking • http://thesgem.com/2018/11/sgem237-screening-tool-for-child-sex-trafficking/ • https://omgfacts.com/this-horrifying-map-shows-sex-slavery-spots-across-the-us/ • https://www.acepnow.com/article/how-to-spot-and-help-human-trafficking-victims-in-the-emergency-department/ • https://www.emra.org/globalassets/emra/be-involved/events--activities/casecon/2018-posters/group-1/shacelles_bonner_final_poster.pdf • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5468066/ • https://www.annemergmed.com/article/S0196-0644(16)30054-3/abstract • https://www.acepnow.com/article/the-complexities-of-recognizing-and-responding-to-trafficked-patients-in-the-ed/ • https://www.acepnow.com/bring-awareness-human-trafficking-medical-practice/ • http://polarisproject.org/sites/default/files/us-citizen-sex-trafficking.pdf

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