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Survivors of child sex trafficking (SCST) experience high rates of adverse health outcomes. Amidst the duration of their victimization, survivors regularly seek healthcare yet fail to be identified. This study sought to utilize artificial intelligence (AI) to identify SCST and describe the elements of their healthcare presentation. An AI-supported keyword search was conducted to identify SCST within the electronic medical records (EMR) of ∼1.5 million patients at a large midwestern pediatric hospital. Descriptive analyses were used to evaluate associated diagnoses and clinical presentation. A sex trafficking-related keyword was identified in .18% of patient charts. Among this cohort, the most common associated diagnostic codes were for Confirmed Sexual/Physical Assault; Trauma and Stress-Related Disorders; Depressive Disorders; Anxiety Disorders; and Suicidal Ideation. Our findings are consistent with the myriad of known adverse physical and psychological outcomes among SCST and illuminate the future potential of AI technology to improve screening and research efforts surrounding all aspects of this vulnerable population., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Women and girls remain substantially overrepresented in the commercial sex industry. While a number of outcomes have been linked to childhood abuse and involvement with the commercial sex industry, there exists a gap in understanding the unique impact of child abuse on child custody outcomes among adult women involved in the commercial sex industry. Drawing from data collected from 107 case files of adult women with a history of commercial sex industry involvement, the aim of the current study was to understand the link between child abuse history, commercial sex industry involvement, and child custody outcomes. Results indicated that among women who reported a history of child sex trafficking, 91.7% reported having endured child abuse. Further, 82.4% of women reported that their children were not under their custody. Dysfunctional family dynamics, substance abuse, and economic and structural barriers endured by these women are explored further, and intergenerational continuity of such traumagenic precarities is considered as a prolonged implication of such issues. Through a trauma-informed perspective, implications for prevention and intervention are discussed.

Background: Sex trafficking is highly prevalent, pernicious, and under-recognized. When an individual is trafficked for the purpose of sexual exploitation within the borders of a single country, it is termed domestic sex trafficking. Sex trafficked persons can experience severe physical and mental health outcomes requiring medical attention and treatment. However, health care providers often fail to identify sex trafficked patients, missing opportunities to provide needed care and support., Methods: In this qualitative study, we interviewed 31 health care providers (physicians, nurses, and social workers) working in Ontario, Canada to learn what they identified as their specific education and training needs to recognize and care for sex trafficked persons. Interviews were conducted over Zoom, recorded, and transcribed. Coding of the transcripts followed a standard framework for qualitative studies. Codes related to the education and training needs of providers were identified as a core issue suited to further analysis., Results: Three themes related to providers' education and training needs emerged. These acknowledge basic (Foundational knowledge), as well as more specific learning needs (Navigating the encounter). The final theme, ("It just seems so much bigger than me") suggests that even with some knowledge of domestic sex trafficking, participants still experienced considerable distress and multiple challenges due to gaps in the broader system impacting the provision of appropriate care., Conclusions: Participants voiced their need for specialized sex trafficking education as well as role specific training to combat their sense of inadequacy and provide better care for their patients. Participants' education needs ranged from requiring the definition of domestic sex trafficking and the frequency of its occurrence, to the various circumstances associated with increased risk of recruitment into sex trafficking. In terms of desired training and specific skills, participants wanted to learn how to identify a person being sex trafficked, broach the subject with a patient, know what to do next including access to local resources and referrals, as well as connections to other critical services, such as legal and housing. The results can be used to inform the design and content of education and training on sex trafficking for health care providers., (© 2024. The Author(s).)

Background: Sex trafficking victims often have touchpoints with salons for waxing, styling, and other body modification services required by traffickers. Recently, some states have administered laws requiring salon professionals to receive intimate partner violence (IPV)-related training, with even fewer states mandating training on identifying sex trafficking. This study aimed to understand how salon professionals have witnessed evidence of violence, including IPV and sex trafficking, in the workplace and to explore the differences in their approach to each type of victim., Methods: In-depth interviews were conducted with salon professionals (N = 10) and law enforcement professionals/policymakers (N = 5). Content and thematic analysis techniques were used., Results: Salon professionals typically identified potential violence through signs such as bruises, odd behavior, and client disclosures, prompting them to engage in cautious conversations. Yet, few were trained to identify and intervene. Often, they responded to suspected violence by talking with the client, sharing concerns with salon leadership, directly intervening on the client's behalf, or contacting the police. Law enforcement and salon professionals had suggestions about improving salon professionals' recognition of and response to violence, including training on victim-focused resources, creating a safe environment, and building relationships with law enforcement. They also suggested strengthening community partnerships to increase resource advocacy and reporting., Conclusions: One-on-one salon services may provide a unique opportunity to intervene and identify victims of violence, especially when empowered through additional training and collaborative partnerships with community-oriented policing initiates. Implementing training and community-based initiatives could aid salon professionals in gaining greater confidence in knowing what to do when serving a client who is a victim of IPV or sex trafficking., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Introduction: Human trafficking (HT) is a public health issue that adversely affects patients' well-being. Despite the prevalence of trafficked persons in health care settings, a lack of educational modules exists for use in clinical contexts. We developed a 50-minute train-the-trainer module on HT., Methods: After piloting the workshop for faculty, fellows, and residents ( n = 19) at the Society for Academic Emergency Medicine (SAEM) national conference, we implemented it in medical students' curricula during their emergency medicine clerkship at the University of Iowa ( n = 162). We evaluated the worskhop by (a) a retrospective pre-post survey of self-reported ability to (1) define HT, (2) recognize high-risk signs, (3) manage situations with trafficked persons, and (4) teach others about HT, and (b) a 3-month follow-up survey to assess longitudinal behavior change., Results: In both contexts, results demonstrated improvement across all learning outcomes (pre-post differences of 1.5, 1.3, 1.9, and 1.7 on a 4-point Likert-type scale for each learning objective above, respectively, at the SAEM conference and 1.2, 1.0, 1.3, and 1.3 at the University of Iowa; p < .001 for all). In the 3-month follow-up, we observed statistically significant changes in self-reported consideration of and teaching about HT during clinical encounters among learners who had previously never done either ( p < .001 and p = .006, respectively)., Discussion: This train-the-trainer module is a brief and effective clinical tool for bedside teaching about HT, especially among people who have never previously considered HT in a clinical context., (© 2024 Young et al.)

Introduction: Human trafficking is a heinous crime and violation of human rights affecting between 25 and 27 million adults and children globally each year. Current immigration and refugee policy could exacerbate the human trafficking public health crisis. Health care providers working in emergency department and urgent care settings interact with human trafficking victims and provide life-changing care. Research identifies a significant need for coordinated, consistent, and standardized education on human trafficking. The purpose of this study was to determine the effectiveness of online educational training in human trafficking on the knowledge and self-confidence of registered nurses and nurse practitioners working in the emergency department and urgent care settings in New York., Methods: An asynchronous, online education module was designed for emergency department and urgent care registered nurses and nurse practitioners to address key components of human trafficking identification, assessment, and treatment. Using a 1-group pretest/posttest design, participants completed an existing published survey tool before and 6 weeks after education., Results: Findings revealed statistically significant improvement (P < .05) in knowledge and confidence regarding components of identifying, assessing, and treating victims of human trafficking. Data demonstrated 63.8% of participants had never received human trafficking training, and 80% reported no history of contact with patients known or suspected of being trafficked., Discussion: Results in this study demonstrate the need for increased standardized education regarding HT for frontline health care workers., (Copyright © 2024 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.)

Background: Sex trafficking of persons, a pervasive public health issue disproportionately affecting the most marginalized within society, often leads to health as well as social consequences. Social service provision to meet the resulting needs is critical, however, little is known about the current pandemic's impact on providers' capacity to deliver requisite care., Method: To examine social service providers' perspectives of care provision for domestically sex-trafficked persons in Ontario, Canada, during the COVID-19 pandemic, we conducted semi-structured interviews with 15 providers and analyzed these using Braun and Clarke's analytic framework., Results: Impacts of the COVID-19 pandemic on social service care provision were connected to individuals' increased vulnerability to trafficking, difficulties safely and effectively providing services to sex-trafficked persons amid pandemic restrictions, and reduction in in-person educational activities to improve providers' capacity to serve this client population. Securing safe shelter was particularly difficult and inappropriate placements could at times lead to further trafficking., Conclusion: The pandemic created novel barriers to supporting sex-trafficked persons; managing these sometimes led to new and complex issues. Future efforts should focus on developing constructive strategies to support sex-trafficked persons' unique needs during public health crises.

The aim of this study was to examine the associations between adverse childhood experiences (ACEs) and the high levels of social service usage by women who are sex trafficked. Fifty (N = 50) women who were sex trafficked were surveyed using purposive and snowball sampling methods. The ACEs score for respondents ranged from 2 to 10 with an average score of 7.4 (SD = 2.3). Emotional and sexual abuse tied at 88 percent as the most frequently cited ACEs among the women in this sample. The prevalence of ACEs was significantly higher in this sample compared with known estimates in similar populations, ranging from 20 percent to 54 percent (p < .001). Considering the well-established link between ACEs and poor health outcomes, these findings point to the need for innovative and targeted social service provisions to women who were formerly sex trafficked that take into consideration the high level of ACEs of the women. Given the sociodemographic diversity of this sample, there is a need for services that are trauma-informed, innovative, and culturally sensitive in a variety of social service settings., (© 2024 National Association of Social Workers.)

There is a dearth of research on trauma bonding among victims of sex trafficking. This study aims to fill this gap by seeking to understand how service providers working with survivors of sex trafficking conceptualize and observe trauma bonding in their clients. This qualitative study involved interviews with 10 participants. Purposeful sampling was employed among licensed social workers or counselors. Two themes emerged: defining trauma bonding (with four subthemes: embracing intensity, power imbalance, distortion of love, and inescapability) and the development of trauma bonds (with three subthemes: universality, gendered, and grooming). These findings provide much-needed insight into the complexities of trauma bonding., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The child welfare system is pivotal in identifying and responding to child (younger than age 18) human trafficking victims. Children who have experienced human trafficking-or are at risk of victimization-are increasingly recognized as also being served in the juvenile justice system. Yet little is known about human trafficking victimization among children in the juvenile justice population or among children with child welfare and juvenile justice involvement., Objective: Building on previous research with child welfare-and juvenile justice-involved children, we investigated characteristics and system experiences among children who have experienced a human trafficking abuse allegation in Florida., Participants and Setting: The overall study population included all children born on or after January 1, 1993, who had at least one DCF-documented maltreatment allegation before March 1, 2020. This study examined a total of 12,167 allegations in the first set of analyses and the first human trafficking allegation for each child (N = 9300) in the second set of analyses., Methods: Analyses are based on linked administrative data for a cohort of children involved with Florida's Departments of Juvenile Justice (DJJ) and/or Children and Families (DCF). We used descriptive and multivariate logistic regression analyses to document the characteristics of single and dual system-involved children and examine predictors of child welfare, juvenile justice, and dual system involvement., Results: (1) Nearly half of children with a human trafficking abuse allegation are involved in DCF at the time of the allegation, (2) females who experienced trafficking are more likely to be involved in DCF (with or without DJJ involvement) than involved in no system, (3) Black children with an alleged trafficking incident were more likely than White children to be involved in both systems compared with DCF only, and (4) children who experienced labor trafficking abuse allegations were less likely than those who experienced sex trafficking to be involved with either system., Conclusions: This study depicts child victims of sex and labor trafficking who are involved with one or both systems in one state., Competing Interests: Declaration of competing interest None., (Copyright © 2023. Published by Elsevier Ltd.)

Purpose: This study assessed the characteristics that place adolescent girls at greatest risk for sex trafficking involvement. It was hypothesized that girls with a greater history of risk behaviors, unstable home environments, child maltreatment, and increased psychiatric complexity would be more likely to be involved in domestic minor sex trafficking (DMST)., Methods: Retrospective chart review of two cohorts of adolescent girls, one with known DMST history, and an age-matched cohort without DMST history, was conducted. Patients came from a Child Abuse clinic and primary care clinic within a single large urban children's hospital in the Northeast United States. Multivariate clustering analysis identified two groups of patients within the sample, one sharing "low risk" traits, and one with "high risk" traits. A variable for "psychiatric complexity" and its relationship to DMST risk was assessed. Hypothesis tests of mediation were conducted., Results: 44 DMST patients and 181 Primary Care patients were included in the final sample, who were then grouped into two clusters based on conceptualized "risk" characteristics. Hypothesis testing supported evidence that patients in the "high risk" group tended toward higher psychiatric complexity (p = .0016) and greater likelihood of DMST involvement (p = .0328). Patients with increased psychiatric complexity also tended towards DMST involvement, regardless of "risk" cluster (p < .0001)., Discussion: This study demonstrates the relationship between social characteristics, psychiatric problems, and DMST involvement. We demonstrated that adolescents with increased psychiatric complexity tend towards greater risk of DMST. These findings demonstrate the important relationship between psychiatric complexity and sexual victimization., (Copyright © 2023 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Sex trafficking has been identified as a prominant health and human rights concern in Canada. However, there has been little empirical research on the topic and existing studies are largely found within the grey literature. This review sought to identify and summarize the current scholarly literature about sex trafficking of women and girls in Canada. We identified empirical studies using a keyword search in ProQuest, Web of Science, and Scopus. Eligible articles were published in English in 2000 or later, included a focus on women victim/survivors, and analyzed human/participant data. Only 14 studies met eligibility criteria. Most studies were qualitative, based on interviews or focus groups primarily with stakeholders, and set in the province of Ontario. Key findings highlighted challenges in conceptualizing sex trafficking centered largely around issues of coercion and consent. Pathways into trafficking (economic displacement, past abuse, and broken ties with family and community) and gaps and barriers in anti-trafficking responses (narrow or conflicting definitions, stigmatization and criminalization of sex work, and a lack of accessible or appropriate services) particularly impacted Indigenous, im/migrant, and other marginalized women and girls. There is a pausity of empirical studies on sex trafficking in Canada and this has implications for the development of data-driven policies and protocols. Further research should seek to highlight the voices of survivors and impacted communities and evaluate strengths and limitations of Canadian anti-trafficking interventions.

Human trafficking is one of the largest criminal enterprises in the world, generating an estimated $150 billion in illegal profits annually. Sex trafficking is the most common form of human trafficking, and survivors experience significant physical, emotional, and sexual trauma that places them at increased risk of poor health outcomes. As sex trafficking continues to disproportionately impact the physical and mental health of individuals belonging to marginalized groups, a multidisciplinary approach to combat trafficking will require collaboration between health services, law enforcement, and social services. Therefore, medical professionals should be familiar with screening protocols for trafficking and evidence based, trauma-informed mental health treatment interventions., (Published by Elsevier Inc.)

Introduction: Human trafficking (HT) awareness campaigns can educate the public and specific professional figures about this crime and ways to prevent it. However, there currently remains a gap in terms of how to best frame such campaigns without stigmatizing groups of individuals or portraying victims in unrealistic ways., Methods: We conducted four focus groups with 22 experts in HT to explore their perspectives and opinions on current challenges in the framing of HT awareness campaigns in the United States. Focus groups were conducted via Zoom and transcribed verbatim. Two independent reviewers analyzed the transcripts to identify themes using an inductive approach. The results of the focus groups analysis were used to structure the guiding questions of a brainstorming technique named Nominal Group Technique (NGT). Fifteen of 22 experts that participated in the focus groups joined the in-person NGT with the intent of generating ideas and achieving consensus on target audiences, goals, and content of human trafficking awareness campaigns. At the end of the NGT participants ranked priority for actions in the development of HT awareness efforts in the United States., Results: During the NGT the experts provided a number of recommendations to improve HT awareness and to empower victims to reach for help. They pointed to the need for: awareness efforts that describe HT on a spectrum of human abuse and exploitation; training for professional figures about trauma-informed care and communication; and efforts that empower trafficked victims to seek support. They also pointed to the need to develop awareness efforts tailored to local needs in close collaborations with the community-based organizations that can champion their dissemination and be the primary point of access for victims seeking help., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Savoia, Piltch-Loeb, Muibu, Leffler, Hughes and Montrod.)

Despite increased awareness of sex trafficking of minors in the U.S., prosecution of traffickers remains difficult, in part because of victim uncooperativeness. There are questions about how that uncooperativeness is expressed, whether it is evident in successfully prosecuted cases, and whether it is unique to trafficked minors or it emerges in similar age victims of sexual abuse. To provide insight relevant to these questions, we compared appellate opinions in two types of successfully prosecuted criminal cases: sex trafficking and sexual abuse of adolescent victims. In the trafficking opinions, victims were rarely described as disclosing on their own or as knowing their trafficker before the victimization. The opinions also often alluded to the trafficking victims' uncooperativeness and delinquency history, and frequently mentioned electronic evidence and prosecution experts. The sexual abuse opinions, in contrast, tended to suggest that victims' own disclosures initiated the case, perpetrators were known and trusted adults, and caregiver support during the case was common. Finally, the sexual abuse opinions never explicitly mentioned victim uncooperativeness or electronic evidence and rarely mentioned expert testimony or delinquency. The different characterizations of the two case types highlight the need for improved education concerning effective prosecution of sex crimes against minors.

While research has demonstrated a complex relationship between sex trafficking and substance use, the relationship between substance use and trauma bonding is not well understood. A trauma bond refers to an emotional attachment that can develop between victims and their abusers. This study aims to explore the relationship between substance use and trauma bonding among survivors of sex trafficking from the perspective of service providers working directly with survivors of sex trafficking. This qualitative study involved in-depth interviews with 10 participants. Purposeful sampling was employed among licensed social workers or counselors working directly with survivors of sex trafficking. Audio recordings of interviews were transcribed and coded using aspects of a grounded theory approach. Three themes emerged from the data regarding the relationship between substance use and trauma bonding among survivors of sex trafficking: substance use as a tactic, substance use as a risk factor, and substance use as a potential trauma bond. These findings support the need to treat substance use and mental health concerns concurrently among sex trafficking survivors. Additionally, these findings can inform legislators and policymakers as they consider the needs of survivors., (© 2023 National Association of Social Workers.)

Background: Although screens for commercial sexual exploitation of children (CSEC) have been developed, little is known about how adolescents at high risk for, or victims of, CSEC compared to non-CSEC adolescents in healthcare utilization as previous studies have not included a control group., Objective: Identify where and how often CSEC adolescents presented to medical care in 12 months prior to being identified as compared to non-CSEC adolescents., Participants and Setting: Adolescents between 12 and 18 years seen in a tertiary pediatric health care system in a Midwestern city with a metropolitan population of >2 million., Methods: This was a 46-month retrospective case-control study. Cases included adolescents who screened high risk or positive for CSEC. Control group 1 included adolescents who screened negative for CSEC. Control group 2 were adolescents who were not screened for CSEC, matched to cases and to control group 1. The three study groups were compared for frequency of, location of, and diagnosis given for medical visits., Results: There were 119 CSEC adolescents, 310 CSEC negative, and 429 unscreened adolescents. Compared to the controls, CSEC positive adolescents sought care less frequently (p < 0.001) and were more likely to present to an acute care setting (p < 0.0001). CSEC cases sought medical care in the acute setting more commonly for inflicted injuries (p < 0.001), mental health (p < 0.001), and reproductive health (p = 0.003). In primary care, CSEC adolescents were more commonly seen for reproductive health (p = 0.002) and mental health (p = 0.006)., Conclusions: CSEC adolescents differ from non-CSEC adolescents in frequency, location, and reasons for seeking healthcare., Competing Interests: Declaration of competing interest The authors have no conflicts of interest relevant to this article to disclose., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

In the United States, sex-trafficking awareness and prevention has increasingly become part of government-mandated health education. This exploratory study surveyed 250 U.S. adolescents to learn more about the use of media narratives in curricula about sex trafficking in light of research findings about victim-blaming responses to survivor narratives, as well as adolescents' still-developing emotion-regulation skills. Victim blaming is counterproductive to the goals of trafficking awareness and prevention curricula. Participants viewed one of four narrative messages about a sex-trafficking victim/survivor. Over half of participants reported victim-blaming responses after viewing the message. Participants reported low perceived efficacy regarding the ability to recognize the signs of trafficking, and some participants experienced intense fear responses to the messages. Victim blaming was not associated with fear or perceived efficacy, contradicting predictions from the Extended Parallel Process Model. This study concludes with recommendations for educators and others tasked with communicating with adolescents about sex trafficking.

Purpose of Review: Sex trafficking is a significant global problem that results in millions of individuals being sexually exploited annually. This paper will provide an overview of recent research in the field of sex trafficking and evaluate findings to provide recommendations for future research and policy work., Recent Findings: In recent years, there has been an increase in research focused on understanding sex trafficking and how it can be prevented. Specifically, recent studies have explored characteristics of sex trafficking cases, risk factors for experiencing sex trafficking, recruitment and maintenance processes, identification and intervention techniques, and treatment approaches. While there have been significant strides to better understand sex trafficking across the globe, numerous areas require further exploration. Additional research conducted internationally and with adults who have experienced sex trafficking is needed to better understand methods that can identify individuals at risk for being trafficked, enhance early detection, and provide services to trafficked individuals., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Human trafficking (HT) is a substantial public health problem, and health care workers are uniquely positioned to help identify and care for survivors. Despite this fact, few medical schools incorporate HT training using trauma-informed care (TIC) principles into their curricula. We developed a training session to educate medical students on recognizing HT red flags and providing TIC to HT survivors., Methods: One hundred twenty-seven fourth-year medical students at Rush Medical College attended a 2-hour session consisting of didactic lectures by expert speakers and participated in a group discussion guided by a clinical vignette. Students completed anonymous pre- and postsession surveys that assessed comfort levels in detecting HT red flags and providing TIC. We used a paired t test to compare pre- and postsession survey responses., Results: Ninety-five pre- and postsession surveys were matched with unique identifiers and used for analysis. The results demonstrated significant improvement in all the metrics assessed., Discussion: This training significantly improved medical students' comfort in identifying and caring for HT survivors, addressing an especially important gap in medical school education. This training can be implemented at other institutions to further improve awareness and efforts in identifying and caring for HT survivors while avoiding retraumatization., (© 2023 Brennan et al.)

Background: Sex trafficking of youth involved in the child welfare system is a critical global issue; however, there are limited counter-trafficking programs designed to specifically meet the needs of this population., Objective: The present study aimed to identify components essential to building a model of care for youth involved in sex trafficking in child welfare. The specific goals of this investigation were to: 1) systematically review the literature for programs implemented with child-welfare involved youth at risk of or involved in sex trafficking, and 2) examine convergent and divergent evidence through interviews with experts-by-experience (i.e., survivors and child welfare personnel)., Participants and Setting: 13 child welfare workers and 6 survivors of sex trafficking., Methods: Systematic review identified articles that included programs and interventions for youth involved in sex trafficking in child welfare. Interviews with experts-by-experience were analysed through reflexive thematic analysis. Content analysis was used to examine convergent and divergent evidence between the two noted methods of inquiry (systematic review and interviews with experts)., Results: Findings from the systematic review support a model of care comprised of two overarching components: 1) wraparound supports, and 2) trained caregivers and supported foster homes. Thematic analyses also revealed that experts thought that an appropriate model of care would require child welfare agencies to take a preventative stance, such as conducting early coordinated risk assessments on all youth in care. Convergent with the literature, experts noted the need for enhanced wraparound supports and specific training for caregivers and service providers., Conclusions: Components essential to building a model of care for youth at risk of or involved in sex trafficking in child welfare were extracted and discussed based on the evidence gathered., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Introduction: Understanding substance use and treatment needs for survivors of human trafficking remains an underdeveloped area in the field of substance use treatment. This study assessed the nature of substance use among survivors of all types of human trafficking and identified treatment barriers and needs, as reported by human trafficking service providers in one Midwest major metropolitan area., Methods: Participants were purposively selected from agencies that served foreign-born and domestic-born survivors of human trafficking. The study interviewed fifteen key informants across 13 agencies directly serving survivors of trafficking., Results: Providers highlighted frequent use of alcohol and marijuana, as well as polysubstance use. They noted survivors' significant use of opioids, associated concerns regarding fentanyl-related deaths, and increased frequency of stimulant use. Barriers for addressing substance use problems with survivors included low self-perceptions of need, lack of available residential or inpatient treatment options, and prioritizing basic needs such as housing over substance use treatment., Conclusions: Results underscore how broader trends in substance use and overdose in a region can mirror substance use patterns and treatment needs of human trafficking survivors. Further, a need exists for broader substance use screening and low-barrier referral services to address emergent needs of survivors of trafficking., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Thousands of Indian women and girls enter the commercial sex industry (CSI) annually based solely on membership in particular castes (e.g., Bedia, Nat). CSI-involved females bear the burden of sustaining entire family units on money earned in the sex trade; it is a life-long responsibility with negligible social status or personal indemnity. Based on the life-course developmental theory (Elder, Jr. 1994, 1998) this investigation was intended to examine trafficked women's experiences within the commercial sex industry across time. Beyond the CSI, we were equally interested in experiences with factors that could promote well-being (i.e., social support) and normative developmental transitions including education attainment and motherhood. To that end, three questions were posed. First, to what extent do factors surrounding CSI entry and continued involvement differ through time among CSI-involved Bedia? Second, how do CSI-involved Bedia describe social network composition and perceived support through time? Finally, are differences detectable, through time, in CSI-involved Bedia women's experiences with normative developmental transitions including education attainment and motherhood? Interview data were collected from 31 Bedia females (age range 17 - 65 years) residing in rural Madhya Pradesh, India. To examine change through time, participants were divided into cohorts based on age and time involved in the commercial sex industry. Data were then analyzed within and across cohorts with particular attention to cohort-related experiential differences. Policy implications and suggestions for continued research are presented., (Published by Elsevier Ltd.)

Resilience is critical among survivors of trafficking as they are mostly vulnerable populations who face multiple adversities before, during, and after trafficking. However, resilience in survivors of trafficking is understudied. This scoping review aims to clarify the current state of knowledge, focusing on definitions of resilience, how resilience has been studied, and factors associated with resilience among survivors. Five databases were searched using key words related to trafficking and resilience. Studies were included if they were published in English between 2000 and 2019 and focused on resilience with the study design including at least one of these four features: (a) use of standardized measures of resilience, (b) qualitative descriptions of resilience, (c) participants were survivors or professionals serving survivors, and (d) data sources such as case files or program manuals directly pertained to survivors. Eighteen studies were identified. Findings indicated that resilience was primarily described as emergent from interactions between the survivor and the environment. Resilience in trafficking appeared largely similar to resilience in other kinds of victimization. Nonetheless, trafficking survivors also may display resilience in alternative ways such as refusing treatment. Positive interpersonal relationships were the most commonly mentioned resilience factor. In addition, current research lacks studies featuring longitudinal designs, interventions, participatory methods, types of trafficking other than sexual trafficking, and demographic characteristics such as age, gender, and national origin. Future research needs to establish definitions and measures of resilience that are culturally and contextually relevant to survivors and build knowledge necessary for designing and evaluating resilience-enhancing interventions.

The aim of this study was to validate and analyze the psychometric properties of a Spanish version of the Sexual Trafficking Attitudes Scale towards women and girls (STAS). A sample of 204 students from the University of Salamanca (Spain) was used. The exploratory factor analysis and confirmatory factor analysis confirmed a multifactorial structure of six factors (70.1% of variance). The Cronbach's α internal consistency index obtained for the sample was 0.87 and composite reliability was 0.94. Convergent validity was determined between the full scale and the six dimensions, and divergent between subscales. The Spanish version of the instrument consisted of 25 items, proving to be a reliable and parsimonious measure.

Purpose: This study aimed to assess the perspectives of youth survivors of sex trafficking on healthcare to improve care for this vulnerable and often unrecognized population., Design and Methods: Semi-structured focus groups were conducted with eight survivors in Southern California who interacted with the healthcare system while being sex trafficked. Interviews were audio- and/or video-recorded and transcribed verbatim. The analysis utilized a grounded theory approach, where researchers reviewed the data collected, then inductively generated codes and themes based on the findings from the interviews., Results: The focus group interviews revealed the following themes: unequal treatment, barriers to patient care, risk identifiers, support, and survivor recommendations., Conclusions: Youth survivors seeking healthcare reported multiple barriers based on their interaction with healthcare providers, such as the lack of provider awareness, education, training, feelings of shame, judgment, fear, racial biases, and lack of empathy. Improving patient outcomes relies on understanding the complexities of human trafficking and implementing an approach to decrease barriers to care., Practice Implications: This study resulted in invaluable survivor recommendations with practical solutions on addressing human trafficking and exploitation in the healthcare system. The solutions proposed by participants included strengthening relationships and experiences with healthcare providers by increasing awareness, establishing rapport, creating a safe space, asking questions about their safety and situation, using a non-judgmental approach, and providing resources., Competing Interests: Declaration of Competing Interest The authors have no conflict of interest to declare., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Human trafficking, also known as modern-day slavery, is a public health crisis and a growing worldwide crime exploiting approximately 40.3 million victims. A decade ago approximately 79% of human trafficking crimes were related to sexual exploitation and 18% were related to forced labor, but more recent reports show approximately 50% and 38%, respectively. Although sexual exploitation continues to make up the majority of human trafficking crimes, forced labor continues to grow at an alarming rate. The purpose of this paper is 2-fold. First, to empower healthcare providers and community volunteers serving potential victims of human trafficking in traditional and nontraditional settings with human trafficking identification training. This education should include the use of a validated human trafficking screening tool and the timely provision of resources. Second, to guide professional nurses in the holistic approach to caring for potential victims of human trafficking. The core values of holistic nursing practice and Watson's Theory of Human Caring are the pillars guiding mindful and authentic nursing care. Merging evidence-based practice with holistic care will boost victim identification and rescue.

This work investigates the associations between experiences of domestic minor sex trafficking and adolescent interpersonal violence victimizations, including intimate partner violence (IPV) and community violence. Abuse and violence in childhood are commonly proposed as risk factors for domestic minor sex trafficking. However, less is known about how interpersonal violence victimizations in adolescence connect to domestic minor sex trafficking experiences. The poly-victimization framework provides a means to understand domestic minor sex trafficking as a type of violence amid a web of additional interconnected violence victimizations. Efforts to better understand the interpersonal violence experienced by survivors of domestic minor sex trafficking are valuable in contextualizing trafficking experiences for adolescents. Data from The National Longitudinal Study of Adolescent to Adult Health, a population-based sample of adolescents in the United States ( n = 12,605) were used to examine experiences of domestic minor sex trafficking for minor respondents, as measured through questions about exchanging sex for money or drugs. A multivariable logistic regression model was used to estimate the associations between domestic minor sex trafficking and IPV or community violence, while controlling for demographic variables and adolescent risk behaviors. Minors who experience community violence had significantly greater odds of having exchanged sex (aOR: 1.86; 95% CI: 1.32 -2.64). However, IPV was not significantly associated with minors' experiences of sex exchange (aOR: 1.14; 95% CI: 0.85 -1.54). Alcohol or drug use (aOR: 1.87; 95% CI: 1.32 -2.65) and having run away (aOR: 2.04; 95% CI: 1.53 -2.72) were also significantly associated with minor sex exchange. As experiences of domestic minor sex trafficking were significantly associated with community violence victimizations, prevention and intervention efforts targeting youth at high risk for or survivors of domestic minor sex trafficking should consider how community violence victimizations impact these adolescent populations, and programming/messaging should be adjusted to account for these additional violence victimizations.

Aim: To explore the experiences and perceptions of midwives in the treatment of sex trafficking victims., Design: The study was qualitative with a hermeneutic-phenomenological approach, using semi-structured interviews and focus groups., Methods: Two focus groups and six interviews were carried out on 14 midwives in primary care, delivery and emergency rooms. Data were collected in three hospitals in Spain in June 2021. ATLAS.ti 9 software was used to conduct a content analysis of the focus group and interview data., Results: The results revealed two primary themes and six subthemes. The two primary themes were (i) sex trafficking: a camouflaged reality on the invisible spectrum, and (ii) a thirst for attention in the aftermath of violence. Representative quotations were used to illustrate both the main themes and the subthemes., Conclusions: This study provides new insight into midwives' experiences treating sex trafficking victims. Professionals view this type of violence as a silent issue that negatively impacts victims' health and livelihood. However, a number of different factors stand in the way of correctly identifying and treating victims. Therefore, healthcare workers must be provided with practical tools and continuous professional development on this topic., Impact: This study indicates the importance of the midwives' key role in identifying and assisting victims of sex. Not only do measures in the healthcare setting, such as on-going specific-related content training or up-to-date protocols, need to be implemented to ensure proper care for those affected by sexual exploitation, but also focusing on suspicious characteristics and reducing obstacles to patient communication will help bring the true situation to light and better respond to patients' priority needs., (© 2022 John Wiley & Sons Ltd.)

In the courtroom, the credibility of sex trafficking survivors is often called into question. Particularly of interest are the survivors' complex behaviors and reactions, which may be misunderstood as being incongruent with claims that they were sex trafficked. Expert testimony may be essential to help the trier of fact understand the seemingly counterintuitive behavior of trafficking survivors. This article describes current laws against sex trafficking and challenges to prosecution arising from common misconceptions about survivors. We summarize clinical research on the mental health sequelae of sex trafficking. We review published judicial opinions that describe the use of expert testimony in sex trafficking prosecutions. Our case review shows that forensic psychiatrists are infrequently used as experts in this setting. Forensic psychiatrists, particularly those with expertise in traumatic stress or sex trafficking, can play an important role in explaining how trauma and psychopathology can cause survivors to recant testimony, be reluctant to engage, or respond in other ways that weaken their perceived credibility. Forensic psychiatrists can also assess for treatment needs to calculate restitution for trafficking survivors more accurately., (© 2022 American Academy of Psychiatry and the Law.)

Trafficked youth have numerous needs that must be addressed to give them opportunities to rebuild their lives. Few organizations offer comprehensive services to meet all these needs, which forces survivors to seek out services from multiple organizations and puts them at risk for not receiving important services. This study highlights the needs of organizations in an interagency task force that serve trafficked youth to identify barriers and generate potential solutions to service provision challenges. We conducted a mixed-methods needs assessment by conducting interviews with 15 service providers belonging to a regional human trafficking task force, which revealed a need for more services for trafficked youth, particularly in criminal justice and gender-based violence organizations. Implications of these findings include a need for centralized referral processes and more prevention services, such as a youth drop-in center and educational interventions.

Aims: The aims of this study were to (1) explore the barriers and challenges of sex trafficking identification and (2) understand how sex trafficking indicators are perceived (i.e. relevance and utility) by healthcare providers at five sites of a large sexual health care organization in a Midwestern state within the United States., Design: A qualitative, collective case study was conducted., Method: In-depth, semi-structured interviews were conducted with 23 healthcare staff (e.g. medical assistants, nurse practitioners) who provided sexual and reproductive healthcare between fall 2018 and spring 2020., Results: Findings suggest that providers perceived behavioural and verbal sex trafficking indicators (e.g. patients appearing nervous or being unable to answer questions) as relevant, particularly with a female patient accompanied by a 'controlling' male. Medical and physical indicators (e.g. repeat STIs, bruises and tattoos) were perceived as generally lacking clinical utility or irrelevant. Some indicators were only perceived as relevant when combined or only later, upon reflection (e.g. older, female adult accompanying one or more female patients)., Conclusion: Healthcare providers may be aware of sex trafficking indicators conducive to identifying female patients, in relationships with older men, who are at risk of sex trafficking. Our study finds that healthcare providers may not be aware of all recommended sex trafficking indicators and the nuances of how patients present., Impact: Provider trainings on sex trafficking dynamics and nuanced clinical presentations should include observing ST indicators in simulated interviews, assessing and safety planning (including using harm reduction strategies) with seemingly ambiguous cases. In addition, we recommend that trainings emphasize the relationship between the continuum of agency and victimization in sex trafficking and patient presentations., (© 2021 John Wiley & Sons Ltd.)

During their clinical practice, nursing students face a number of complex clinical situations, which may include treating victims of sex trafficking. These clinical experiences can lead to stress for the nursing students, which may hinder their learning process. Nonetheless, there is very little educational training provided in nursing programmes on this topic. The objective of this study was to identify the coping strategies and stressors perceived by nursing students in the care of sex trafficking victims. A pre-post study of a single group was carried out. The TREND guidelines were followed. The Perceived Stress Scale (PSS) and Coping Behavior Inventory (CBI) were used for data collection. On the PSS, the average scores were lower after the intervention in all dimensions, except related to teachers and nursing staff and peers and daily life. Statistically significant differences were found when comparing the results of the total average score of the PSS and the time of measurement (pre/post-intervention) (t(106) = 38.811; P < 0.001). Regarding the Coping Behavior Inventory, the average scores in each dimension increased after the intervention, except transference behaviours. Statistically significant differences were found when comparing the total average score of the questionnaire and the time of measurement (Z = -13.357; P < 0.001). The total stress levels and coping strategies of nursing students in caring for victims of sex trafficking improved significantly after the intervention. Nursing educators should promote the training of future nursing professionals as a potential effective strategy for the rapid identification and adequate care of sex trafficking victims., (© 2021 John Wiley & Sons Australia, Ltd.)

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., (© 2021 by the Society for Academic Emergency Medicine.)

Objective: The United States' Institute of Medicine recommends that health care providers be aware of sex trafficking (ST) indicators and conduct risk assessments to identify people at risk. However, the challenges among those who conduct such assessments remain largely understudied. The aim of this study was to understand the perceived barriers to ST risk assessment among health care providers in a large health care organization., Methods: This study used a collective case study approach in five sites of a large health care organization that serves high-risk populations in a Midwestern state. Twenty-three in-depth, semi-structured interviews were conducted with health care staff (e.g. medical assistants, nurse practitioners). Two research team members conducted independent deductive coding (e.g. knowledge of ST), and inductive coding to analyse emerging themes (e.g. responses to ST risk or commercial sex disclosures, provider role ambiguity)., Results: Although staff routinely screened by asking 'Have you ever traded sex for money or drugs?', participants primarily described avoiding further discussions of ST with adult patients because they (1) aimed to be non-judgmental, (2) viewed following up as someone else's job, and/or (3) lacked confidence to address ST concerns themselves, particularly when differentiating sex work from ST. Differences all emerged based on clinical context (e.g. urban location)., Conclusions: There may be missed opportunities to assess patients for ST risk and use harm-reduction strategies or safety plan to address patients' needs. Implications for practice, policy, and future research are discussed.

Introduction: Trafficked youth experience complex health issues such as substance abuse, severe physical trauma, and sexual health problems, with many entering trafficking between 15 and 17 years old. There is increasing awareness of the need to educate pediatric health care providers on identifying and aiding trafficked children; however, critical gaps in the literature exist regarding educational sessions specific to the human trafficking of pediatric patients. Our objective was to implement and evaluate a survivor-informed educational session for pediatric resident physicians to improve identification of and assistance to trafficked youth in the clinical setting., Methods: We designed an educational session on human trafficking, which included a 60-minute interactive didactic presentation and distribution of a point-of-care reference tool, in collaboration with a survivor of human trafficking, for 59 pediatric trainees in 2019. We utilized pre/post knowledge assessments. Data analysis included descriptive statistics and Fisher exact analysis., Results: Of 99 total eligible residents, 59 (59%) participated. Statistically significant increases in correct identification of hypothetical trafficked youth and next steps for intervention were observed. Over 80% of participants reported comfort with defining, recognizing, referring to, and understanding health consequences of human trafficking on the postassessment, compared to 25% on the preassessment ( p < .001)., Discussion: Our educational session resulted in statistically significant increased comfort in identification of human trafficking victims and can be replicated at other institutions. The point-of-care reference tool-which can be adapted for use in different settings-can guide pediatric residents in managing suspected trafficked youth in the clinical setting., (© 2021 Garg et al.)

Commonly reported sex trafficking indicators have been disseminated widely by government and non-governmental organizations in trainings aimed to increase identification and referral to resources. However, very little research evaluates such indicators. Drawing from survey responses of 86 social service providers, health care practitioners, and justice system officials in a Midwestern City, this pilot study aimed to examine: (a) the pervasiveness of the commonly reported indicators, (b) the salience of domains of indicators, and (c) the extent to which indicators differ across service populations (U.S.-born minors, U.S.-born adults, foreign born minors, and foreign born adults). The most commonly identified indicators included mental health symptoms of depression ( M = 3.82); low self-esteem ( M = 3.59); anxiety ( M = 3.55); low levels of interpersonal trust ( M = 3.52); sense of fear ( M = 3.36); feelings of shame or guilt ( M =3.34); isolation from family, friends, and communities ( M = 3.3); and fear/distrust of law enforcement ( M = 3.80). The least commonly identified indicators included exhibiting low English proficiency ( M = 1.62), previous history of loitering charges ( M = 1.74), presenting false documents ( M = 1.85), presence of tattoos or branding ( M = 1.89), presenting delayed cognitive development ( M = 1.91), being unaware of one's location ( M = 1.94), owing large debt ( M = 1.95), previous history of prostitution or drug charges ( M = 1.98, M = 2.01), and physical evidence of torture ( M = 2.07). The mental health domain was identified as especially common among U.S.-born adults ( M = 3.07). Criminal justice involvement was identified as less common among foreign-born minors ( M = 1.82) and foreign-born adults ( M = 1.96). The most commonly identified indicators, according to the service providers, health care workers, and justice system officials who work with them, are inconsistent with many of the indicators that are used frequently across governmental and community trainings. Trainings focusing on diverse case examples of trafficking may be important in strengthening identification of sex trafficked individuals, as well as accounting for regional contexts.

Human trafficking is a pandemic human rights violation with an emerging paradigm shift that reframes an issue traditionally seen through a criminal justice lens to that of a public health crisis, particularly for children. Children and adolescents who are trafficked or are at risk for trafficking should receive evidence-based, trauma-informed, and culturally responsive care from trained health care providers (HCPs). The purpose of this article was to engage and equip pediatric HCPs to respond effectively to human trafficking in the clinical setting, improving health outcomes for affected and at-risk children. Pediatric HCPs are ideally positioned to intervene and advocate for children with health disparities and vulnerability to trafficking in a broad spectrum of care settings and to optimize equitable health outcomes., (Copyright © 2020 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.)

The study of sexual exploitation of trafficked victims cannot be done without understanding their enforced isolation. To better understand the dynamics of isolation, this study examined how traffickers used different elements of isolation and how such tactics may have contributed to the traffickers' success in maintaining control over the victim(s). We examined in-depth narratives from 14 women between the ages of 20 to 53, primarily immigrants, who were recruited from an agency serving victims of sex trafficking in a large metropolitan city. The tactics used by traffickers varied and included not only the commonly defined structural isolation in which victims are restricted physically and socially, but also included a shrinking of safe social space and an elimination of privacy and social support. The latter, which we label as functional isolation, refers to instances when survivors are surrounded by peers who are either unreliable or aligned with the trafficker and thus are unable to give true social support. Survivors reported a combination of isolation tactics (i.e., both structural isolation and functional isolation). The different interwoven types and patterns of isolation reported by former victims of trafficking help address a dearth in the coercive control and abuse literature, providing a richer understanding of isolation in trafficking survivors.

Background: The trafficking of children and adolescents is widespread, and pediatric providers are on the front line. Current research demonstrates that trafficked children do access health care. However, few studies describe these interactions from their perspectives. In order to elucidate the healthcare experiences of sex trafficked children, we designed a qualitative study utilizing semi-structured interviews to explore their health care interactions., Participants and Setting: Homeless youth currently aged 18-21 who were sex trafficked before age 18., Methods: Semi-structured interviews were conducted with seventeen youth who met the study criteria. Interview transcripts were coded and analyzed using constant comparative methods. Themes were inductively extracted by consensus with the study team, and thematic saturation was determined when no new themes emerged., Results: Themes included: victims endured serious injuries and illnesses without being brought to medical attention, traffickers limited victims' access to care, logistical barriers limited access, traffickers directed victims to lie to providers, and medical providers rarely separated victims to interview them separately resulting in missed opportunities., Conclusions: These themes illustrate the experiences of sex trafficked youth experiencing homelessness and provide pediatric practitioners the opportunity to become more informed and equipped to recognize them. They also highlight serious health consequences of not being identified and egregious examples of providers exhibiting denial or inappropriate responses to their disclosure., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

As trusted health care providers in the school setting, school nurses are positioned uniquely to identify children at risk for or victims of commercial sexual exploitation of children (CSEC). Nevertheless, many victims go unrecognized and unaided due to inadequate provider education on victim identification. This review provides a comprehensive overview of the major risk factors for CSEC of girls aged 12-18, the largest group of CSEC victims in the United States. A search of four databases (Web of Science, CINAHL, PsychINFO, and PubMed) yielded 21 articles with domestic focus, published in English between January 2014 and May 2020. While childhood maltreatment trauma was found most relevant, a variety of other risk factors were identified. Future nursing research is called to address the numerous research gaps identified in this review that are crucial for the development of policies and procedures supporting school nurses in recognizing victims quickly and intervening appropriately.

Purpose: Human trafficking is a public health social work issue. This review aimed to present the current state (nature and extent) of sex trafficking research, categorize best practices, and identify recommendations for professionals., Methods: Comprehensive literature searches of online databases were conducted to identify eligible articles from January 2000 to March 2019., Results: The search yielded 467 studies, 87 met the predetermined criteria for inclusion. Seven themes identified: awareness, identification, at-risk populations, health issues, implementation of trafficking legislation, service and program implementation, and exploiters., Discussion and Implications for Practice: Findings indicate the need for additional research to determine the most effective practices to increase awareness and identification, widespread TVPA implementation, reduce risk factors and resulting health disparities, offer services to survivors and prevention of potential victims., Conclusion: There should be significant efforts to enhance all sex trafficking research in the United States to implement effective, sustainable and evidence-based interdisciplinary interventions.

The global pandemic of severe acute respiratory syndrome coronavirus 2 exacerbates major risk factors for global human trafficking. Social isolation of families and severe economic distress amplify the risk of interpersonal violence, unemployment and homelessness, as well as increased internet use by under-supervised children. Aggravating the situation are overwhelmed health systems, severe limitations in activities of social service organizations, and decreased contact of healthcare professionals with children. Healthcare professionals have a duty to be alert to possible indicators of trafficking, and aware of available victim resources which can be offered to at-risk patients. Healthcare facilities should take steps to increase public awareness of trafficking and community resources., (Copyright © 2020 Greenbaum, Stoklosa and Murphy.)

Objectives: To describe the substance use profiles of youth impacted by commercial sexual exploitation (CSE) and explore associations between substance use with mental health diagnoses and child welfare involvement. Methods: Data were systematically extracted from the court files of 364 youth who participated between 2012 and 2016 in Los Angeles County's Succeeding Through Achievement and Resilience (STAR) Court, a juvenile delinquency specialty court for youth impacted by CSE. Descriptive statistics and multivariate regression analyses were conducted to quantify associations between youths' substance use with mental health diagnoses and child welfare involvement. Results: Of the 364 youth impacted by CSE involved in the STAR Court, 265 youth had documented contact with a psychiatrist while in court-of whom, 73% were diagnosed with at least one mental health challenge. Before STAR Court participation, 74% of youth were the subject of one or more child welfare referral; of these youth, 75% had prior out-of-home care. Eighty-eight percent of youth reported substance use, the most prevalent illicit substances were marijuana (87%), alcohol (54%), and methamphetamine (33%). Controlling for age and race, youth impacted by CSE with a diagnosed general mood disorder had more than five times the odds of reporting substance use compared with those without a mood disorder diagnosis (adjusted odds ratio [AOR]: 5.80; 95% confidence interval CI: 2.22-18.52; p  < 0.001); and youth impacted by CSE with prior child welfare placements had more than two times the odds of reporting substance use (AOR: 2.24; 95% CI: 1.04-4.86; p  = 0.039) compared with youth without prior placements. The association between substance use and general mood disorder was significant and positive for all substance use types (AOR = 3.3, p  = 0.033 marijuana; AOR = 4.01, p  = 0.011 concurrent alcohol and marijuana; AOR = 9.2, p  < 0.001, polysubstance use). Conclusions: High prevalence of substance use among juvenile justice-involved youth impacted by CSE combined with strong associations between substance use with both mental health diagnoses and child welfare system history underscores the need for comprehensive, specialized substance use treatment. Findings suggest an important opportunity for multidisciplinary collaboration among mental health providers, child welfare professionals, juvenile justice practitioners, and other care providers for these youth.

Background: Domestic minor sex-trafficked (DMST) youth experience profound medical and mental health consequences. This retrospective study reviewed healthcare utilization patterns and documented individualized risk factors of sex-trafficked youth in the 5 years prior to presenting to a healthcare setting. The primary aim of this study was to examine healthcare utilization patterns among DMST youth with the goal of determining opportunities for earlier identification within the healthcare system., Methods: A chart review was conducted of all patients <18 years old referred for suspected or confirmed sex trafficking to a child and adolescent protection centre (CAPC) in an urban, academic children's hospital in Washington, DC from January 1, 2006 to March 1, 2017. Patients were seen by a child abuse pediatrician or a trauma-informed social worker in an inpatient, outpatient, or emergency department setting. Demographics and medical, psychiatric, and social history were abstracted from encounters within the hospital's healthcare system along with provider concern for DMST up to 5 years prior to their initial CAPC visit. Descriptive statistics were performed., Results: Thirty-nine patients were identified with a mean age of 14.6 years (SD = 1.7). Ninety percent (n = 35/39) of patients were seen in the healthcare system within the 5 years prior to their initial CAPC visit, totaling 191 encounters. Of the visits, 57% (n = 108/191) occurred in the emergency department. The most common chief complaints for encounters were psychiatric (21%, n = 41/191). Less than half of the youth, 43%, had any documented provider concern for sex trafficking in their medical record prior to identification as DMST., Conclusion: Most of this cohort was previously evaluated within the healthcare system. However, there was limited provider documentation of concern for DMST despite the presence of risk factors. Provider recognition of youth at risk for DMST is crucial for providing care for youth., (© 2020 John Wiley & Sons Ltd.)

The extent to which services are available for and inclusive of diverse survivors of sex trafficking remains understudied. This content analysis in a U.S. Midwestern region designated as a hub explores the availability of sex trafficking-specific organizations and perceived inclusivity of organizations regarding diverse identities (including Lesbian, Gay, Bisexual, Trans, or Queer [LGBTQ]+ and racial/ethnic groups). 186 regional organizations were analyzed, of which only 7 were trafficking specific. Of nontrafficking organizations ( n = 179), less than 12% ( n = 21) stated that they provided services to individuals who identify as LGBTQ+, 6% ( n = 10) included LGBTQ+ symbols/language, 36% ( n = 65) featured perceived People of Color (POC). Lack of inclusive language, photos, and symbols may contribute to trafficking survivors who identify as POC, English language learners, or as LGBTQ+ feeling as though services do not apply to them. Implications are discussed., (© Copyright 2020 Springer Publishing Company, LLC.)

Sex trafficking is recognized as a national problem that inflicts serious harm on its victims, yet, legislative responses to trafficking vary depending on jurisdiction. Federal legislation considers youths who engage in commercial sex acts as trafficking victims. States, however, vary in the evidence required to prove a juvenile is a victim of sex trafficking, as opposed to an offender of prostitution. Using four years of data from the National Incident-Based Reporting System, we compared details of commercial sex incidents involving youths who were identified as trafficking victims or arrested as prostitutes. Beyond legislative differences, comparisons between cases are discussed to illuminate how state law enforcement officials legally classify these events involving adolescents (i.e., as victims or prostitutes). Further, we consider the policy implications of the findings., (© Copyright 2020 Springer Publishing Company, LLC.)

Large gaps exist in our knowledge about the effectiveness of sex trafficking training. This study surveyed knowledge and training regarding sex trafficking among service providers ( N = 66; i.e., social workers, law enforcement offers, and medical providers) in one Midwestern state. The study aimed to: (a) determine the goodness-of-fit between respondents' agency criteria for victim identification and established trafficking definitions, (b) assess training desired and received, and (c) examine group differences in knowledge and training by profession and position. Results suggest confusion exists in defining sex trafficking among aftercare providers despite nearly all respondents indicating they had received training on definition, identification, and vulnerability. Training gaps regarding service coordination, case development, and the legal, mental health, and medical needs of victims remain., (© Copyright 2020 Springer Publishing Company, LLC.)

Introduction: The commercial sexual exploitation of children (CSEC) is a pediatric health care problem with significant physical and mental health consequences for victims, even death. Although there exists community-wide collaborations in the United States to address professional response to CSEC, these efforts often have a limited capacity to reach adolescents and involve them in CSEC prevention. As part of a prevention strategy, the National Institute of Justice recommends educating youth about CSEC and exploiters' recruitment tactics. Despite this recommendation, little is known regarding American youth knowledge of CSEC., Methods: A descriptive research design was used for this study. All adolescents, male and female, presenting to a high-volume urban pediatric hospital-based Midwestern Child Advocacy Center (CAC) due to concerns for alleged sexual abuse were invited to participate in the study by answering a self- administered electronic questionnaire. This questionnaire explores the participants' knowledge, awareness, and attitudes about CSEC, in addition to collecting demographic data, such as participant age, gender identity, grade, school district, and school., Results: During the six-month study period, 286 CAC patients were eligible to participate in the study. Nearly all participants (n = 217; 97%) agreed that pimping is wrong. While the majority of participants indicated an awareness of human trafficking (n = 198; 94%) and sex trafficking (n = 193; 87%); just (n = 91; 41%) had heard of labor trafficking. Fewer participants (n = 55; 25%) identified that a doctor, nurse, or other health care provider had ever spoken with them about sex trafficking., Discussion: Study participants overwhelmingly conveyed negative attitudes toward CSEC. Participating adolescents indicated a significantly higher awareness of sex trafficking (87%) versus labor trafficking (10%). Sex trafficking receives more attention in the media than labor trafficking. Given that study participants indicated hearing about trafficking primarily from the media (74%) and family/friends, this may explain the deficit in labor trafficking awareness. Although study participants demonstrated mostly accurate baseline knowledge of CSEC, that knowledge was not universal., (Copyright © 2019 National Association of Pediatric Nurse Practitioners. All rights reserved.)