Recognizing and intervening in child sex trafficking

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doi:10.12788/jfp.0144

Behavioral Health

Recognizing and intervening in child sex trafficking

J Fam Pract. 2021 January;70(1):29-34 | 10.12788/jfp.0144

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References

1. Samko Tracey (Department of Pediatrics, LA County + University of Southern California, Los Angeles, CA). Conversation with: Vidhi Doshi (Department of Internal Medicine, University of California San Francisco, San Francisco, CA). July 8, 2019.

2. Institute of Medicine; National Research Council. Confronting Commercial Sexual Exploitation and Sex Trafficking of Minors in the United States. Washington, DC: The National Academies Press; 2013.

3. Greenbaum VJ, Titchen K, Walker-Descartes I, et al. Multi-level prevention of human trafficking: the role of health care professionals. Prev Med. 2018;114:164-167.

4. Smith LA, Vardman SH, Snow MA. The national report on domestic minor sex trafficking: America’s prostituted children. 2009. Accessed January 11, 2021. http://sharedhope.org/wp-content/uploads/2012/09/SHI_National_Report_on_DMST_2009.pdf

5. Know the facts: commercial sexual exploitation of children. In: Connections. Summer 2011. Washington Coalition of Sexual Assault Programs. Accessed January 11, 2021. www.wcsap.org/sites/default/files/uploads/resources_publications/connections/Commercial_Sexual_Exploitation_of_Youth_2011.pdf

6. Varma S, Gillespie S, McCracken C, et al. Characteristics of child commercial sexual exploitation and sex trafficking victims presenting for medical care in the United States. Child Abuse Negl. 2015;44:98-105.

7. Walker K, California Child Welfare Council. Ending the commercial sexual exploitation of children: a call for multi-system collaboration in California. 2013. Accessed January 11, 2021. https://youthlaw.org/wp-content/uploads/2015/01/Ending-CSEC-A-Call-for-Multi-System_Collaboration-in-CA.pdf

8. Landers M, McGrath K, Johnson MH, et al. Baseline characteristics of dependent youth who have been commercially sexually exploited: findings from a specialized treatment program. J Child Sex Abus. 2017;26:692-709.

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Psychological effects and trauma exposure. Survivors often have experienced abuse and neglect prior to commercial exploitation, and they may exhibit long-term sequelae. Survivors may present with major depression, anxiety, panic attacks, suicidality, addiction, PTSD, or aggression.¹⁶ Long-term sequelae for patients can include dysfunctional relationships due to an inability to trust, self-destructive behaviors, and significant shame.^2,18

Care and treatment of trafficked youth

Initial presentation may occur in a variety of health care settings. Use a trauma-informed approach emphasizing physical and emotional safety and positive relationships, to reduce risk to the survivor, staff, and providers.¹⁹ Establishing trust and rapport may provide better short-term safety, as well as help build stronger long-term relationships that can lead to better health outcomes.

Clinical examination. Provide traumatized patients with a sense of safety, control, and autonomy in the health care setting. During the physical exam, be aware of the impact of re-traumatization as patients are asked to undress, endure sensitive examinations, and undergo invasive procedures. Explain the examination, ask for permission at each step, and use slow movements. Allow the patient to guide certain sensitive exams.¹⁵ Adopt an approach that recognizes the impact of trauma, avoids revictimization, and acknowledges the resilience of survivors.²⁰

Treatment plan. After the initial exam, treat acute physical injuries and determine if any further testing is needed. Offer emergency contraception, STI prophylaxis, pre-exposure prophylaxis, and vaccines.¹⁵ After assessing patient readiness, offer local resources, identify safe methods for communication, identify individuals who could intervene in a crisis, and consider a safety plan (TABLE 6).

Coordination of care. Consider referrals to behavioral health services, substance recovery centers, food programs, housing resources, and a primary care clinic.¹⁵ ED clinicians may be asked to complete a sexual or physical assault forensic examination. After obtaining informed consent, one needs to¹⁹

document skin signs such as scars, bites, strangulation marks, and tattoos. Note the size, shape, color, location, and other characteristics of each lesion.
perform an oral, genital, and rectal examination and use a sexual assault evidence kit as indicated.
use body diagrams and take photographs of all injuries/physical findings.
order diagnostic testing as appropriate (eg, imaging to assess fractures).

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