Implementation of a screening tool for child sex trafficking among youth presenting to the emergency department - A quality improvement initiative

Detecting orphanage trafficking and exploitation

BACKGROUND

There is growing awareness that a proportion of children in orphanages have been recruited or transferred into the facility for a purpose of exploitation and/or profit. These children are often falsely presented as orphans to evoke sympathy and solicit funding. This process is known as orphanage trafficking. Although orphanage trafficking can be prosecuted under legal frameworks in some jurisdictions, including Cambodia, there have been limited prosecutions to date. One factor that likely contributes to a lack of prosecution is poor detection, yet the indicators of orphanage trafficking have not been considered by extant research.

OBJECTIVE

The current study was conducted as a first step towards providing evidence-based indicators of orphanage trafficking.

PARTICIPANTS AND SETTING

Professionals who had identified or responded to cases of orphanage-based exploitation in Cambodia were interviewed. Participants included criminal justice professionals, investigators from civil society organisations, and child protection social workers.

METHODS

Professionals' perspectives on how to identify orphanage trafficking were explored via in-depth interviews, and the data were analysed via thematic analysis.

RESULTS

The analysis revealed a distinct set of indicators that may be used to detect orphanage trafficking, including the operation of an unauthorised facility, orphanage tourism and volunteering, and an overt focus on fundraising.

CONCLUSION

The indicators revealed in this study point to the need for an effective and thorough monitoring system for orphanages, as well as adequate education and training of relevant personnel to aid in the detection of orphanage trafficking.

Instruments for the Identification of Child Sexual Exploitation: A Systematic Review

To perform a systematic search of instruments for the early identification of risk of sexual exploitation in children (CSE) and appraise their metric properties. Searches were conducted in four electronic databases to identify instruments that only evaluated child sexual exploitation with no restrictions of date or language. Two reviewers independently carried out the initial selection of titles and abstracts, appraisal of the methodological quality, compliance with the entry criteria in the analysis, and extraction of data necessary to systematize the information available. Twenty-three articles were found that used 15 CSE detection instruments. The instruments varied with regard to number of questions, ease of administration, sources of information, rating methods, and the training information provided. What they had in common is that most were designed and used in the English-speaking world, basically in the United States, with few instruments providing solid proof of their validity and reliability in the scores derived thereof. Although instruments were obtained with significant similarities in their conceptualization, differences in multiple characteristics made it difficult to draw clear conclusions regarding their greater or lesser suitability. What did become clear was the need to keep working on obtaining rigorous empirical psychometric evidence.

ICD-10-CM codes infrequently used to document human trafficking in 2019 Nationwide Emergency Department Sample

INTRODUCTION

People who experience human trafficking (HT) visit emergency departments (ED). The International Classification of Diseases, Clinical Modification (ICD-10-CM) introduced codes to document HT in June 2018. The aim of this study is to identify characteristics of ED patients who experienced forced labor or sexual exploitation as a documented external cause of morbidity in US visits.

METHODS

Nationally representative surveillance based on patient visits to 989 hospital-owned EDs in the Nationwide Emergency Department Sample in 2019 became available in 2021. Eight ICD-10-CM codes to classify HT as an external cause of morbidity were combined into one HT variable for analysis in 2021-2022.

RESULTS

A weighted count of 517 of 33.1 million ED visits (0.0016%) documented HT as an external cause of morbidity. Of them, sexual exploitation (71.6%) was documented more frequently than labor exploitation (28.4%). Most HT-related codes were visits by females (87.3%) from large metropolitan areas, and identified as white. Approximately 40% of visits were from ZIP codes with a median household income less than $48,000 annually. Relative to all other ED visits, patients with HT as an external cause of morbidity had higher odds of being female (OR = 6.54, 95% CI:3.59, 11.92) and being a minor (OR = 1.76, 95% CI:1.02, 3.04).

CONCLUSION

HT was rarely documented as an external cause of morbidity in 989 hospitals' ED visits from a nationally representative sample in 2019. Documentation of recently added HT ICD-10-CM codes does not appear to have been implemented sufficiently to yield an unbiased representation of those who experienced HT and presented in the ED. Efforts to enhance the utility of ICD-10-CM HT codes for surveillance and documentation must first address ED personnel training on identification and response to HT. In doing so, ED personnel also need to address ethical concerns (e.g. stigma, confidentiality, risk of patient harm) and allow for informed consent among trafficked patients in order to be scaled up responsibly.