Empowering School Nurses: Enhancing Child Trafficking Awareness and Preparedness in American Public Schools

Child trafficking poses a momentous public health threat to students in public schools. Although school nurses are exceptionally positioned to identify and respond to trafficking, most lack training and resources in this critical area. This project aimed to evaluate the impact of a multifaceted intervention on school nurse preparedness and practices related to child trafficking in an Oklahoma public school district. The project involved Unbound Now's nationally accredited training program for school nurses, implementation of the Fuentes et al.'s Toolkit for Building a Human Trafficking School Safety Protocol (HTSSP) funded by the U.S. Department of Health and Human Services, and facilitation of a roundtable discussion to initiate community collaboration. The results of the pretraining Fraley and Aronowitz School Nurses' Awareness and Perceptions Survey (SNAPS) illuminated variations in school nurses' knowledge and awareness of child trafficking, demonstrating the need for continued training. Post-training evaluations exhibited highly positive feedback, suggesting its effectiveness in meeting the training's objectives. Following the community stakeholder roundtable, the lead school nurse employed the HTSSP toolkit and directed efforts in successfully constructing and implementing a district-wide policy of procedures to respond to suspected cases of human trafficking. However, the project's limitations include a small sample and a single-school district focus. Despite these limitations, this project delivers valuable insights into the challenges and opportunities for enhancing school nurse preparedness in addressing trafficking. This project serves as a foundation for future initiatives to improve students' safety and wellbeing in public schools.

Evaluation of a Human Trafficking Educational Intervention for Nursing Professionals

BACKGROUND

Human trafficking (HT) is a serious public health issue. Survivors of HT seek medical care. Health care professionals may be inadequately trained to identify and support survivors. This study evaluated improvements in nurses' knowledge after a professional development workshop on HT.

METHOD

Pre- and postevaluation surveys assessed nurses' self-reported changes in perceived knowledge of HT and its vulnerability factors, the health impact of HT, strategies for identification and assessment of HT, and response to and follow-up of HT.

RESULTS

After the workshop, participants showed significant improvement in perceived knowledge of all measures, regardless of hours of previous training and years of practice.

CONCLUSION

Perceived knowledge of HT identification and response can be improved through training of nurses, regardless of hours of previous training and years of practice. [J Contin Educ Nurs. 2024;55(1):26-32.].

Health care professionals' self-efficacy in identifying and treating human trafficking victims

BACKGROUND

Human trafficking is characterized as a violation of human rights that exploits males and females of any age for personal or financial gain. Recently, health care professionals have been identified as feasible change agents in this global issue. However, many health care professionals are not trained in identifying and treating human trafficking victims. Through human trafficking education, health care professionals have the potential to be better equipped to recognize and assist trafficking victims and guide them to the specialized care they need.

OBJECTIVE

The purpose of this study was to measure the effect of a trauma-informed human trafficking education intervention and the impact of this training on the self-efficacy of health care professionals in identifying and recognizing human trafficking victims in healthcare settings.

DESIGN

The study was a quasi-experimental research design with snowball and convenience recruitment SETTING: 100 % virtual, online.

PARTICIPANTS

Health care professionals (N = 30) including Nurse Practitioners, Physician Assistants, Registered Nurses, Licensed Practical Nurses, Certified Medical Assistants, Certified Nursing Assistants, Emergency Medical Technicians, and Paramedics from a variety of healthcare settings.

METHODS

30 min total program to include Qualtrics pre-intervention Violence Against Women Health Care Provider survey, 20 min educational intervention on YouTube©, and an identical Qualtrics post-intervention survey.

RESULTS

Total of 30 sets of paired data. The results showed statistically significant improvement in self-efficacy in all survey questions pre- and post-human trafficking educational intervention (p < .001).

CONCLUSIONS

An increase in health care professionals' self-efficacy in identifying and treating human trafficking victims yields better patient and health care system outcomes. Trauma-informed human trafficking education for all health care professionals is recommended.

Human Trafficking Education: An Asynchronous Approach to Improve Nurses' Knowledge and Application

Nurses as healthcare professionals are in key positions to identify trafficked persons. Assessment of nurse knowledge shows the benefit of using asynchronous human trafficking education as a means for learning. Recommendations from this study for professional development educators include garnishing nurse executive support and use of case-study, evidence-based approaches. Support for state-mandated human trafficking education requirements for initial and ongoing licensure of nurses is necessary as human trafficking knowledge may decrease over time.

Trauma-Informed Care Curricula for the Health Professions: A Scoping Review of Best Practices for Design, Implementation, and Evaluation

PURPOSE

Trauma-exposed persons often experience difficulties accessing medical care, remaining engaged in treatment plans, and feeling psychologically safe when receiving care. Trauma-informed care (TIC) is an established framework for health care professionals, but best practices for TIC education remain unclear. To remedy this, the authors conducted a multidisciplinary scoping literature review to discern best practices for the design, implementation, and evaluation of TIC curricula for health care professionals.

METHOD

The research team searched Ovid MEDLINE, Cochrane Library, Elsevier's Scopus, Elsevier's Embase, Web of Science, and the PTSDpubs database from the database inception date until May 14, 2021. Worldwide English language studies on previously implemented TIC curricula for trainees or professionals in health care were included in this review.

RESULTS

Fifty-five studies met the inclusion criteria, with medicine being the most common discipline represented. The most prevalent learning objectives were cultivating skills in screening for trauma and responding to subsequent disclosures (41 studies [74.5%]), defining trauma (34 studies [61.8%]), and understanding trauma's impact on health (33 studies [60.0%]). Fifty-one of the studies included curricular evaluations, with the most common survey items being confidence in TIC skills (38 studies [74.5%]), training content knowledge assessment (25 studies [49.0%]), participant demographic characteristics (21 studies [41.2%]), and attitudes regarding the importance of TIC (19 studies [37.3%]).

CONCLUSIONS

Future curricula should be rooted in cultural humility and an understanding of the impacts of marginalization and oppression on individual and collective experiences of trauma. Moreover, curricula are needed for clinicians in more diverse specialties and across different cadres of care teams. Additional considerations include mandated reporting, medical record documentation, and vicarious trauma experienced by health care professionals.

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.

Characteristics and Perspectives of Human Trafficking Education: A Survey of U.S. Medical School Administrators and Students

Objective: To assess the timing, duration, methodology, and content of human trafficking (HT) curricula in U.S. medical schools. Methods: An anonymous, cross-sectional survey was sent through email and phone to administrators of 199 U.S. allopathic and osteopathic medical schools. A supplementary survey was sent to students and faculty through email listservs and social media links. Data collection occurred from April to October 2020 and findings were analyzed through SAS software. All study measures were approved by the institutional review board. Results: Administrators were from 22 states and 34 schools (n = 51/199 schools; response rate: 25.6%) and n = 41 responded to all questions. Of these, 32% (13/41) self-identified as deans, 34.1% (14/41) as faculty, and 29.3% (12/41) as other administrators. Less than half (41.5%, n = 17/41) reported an HT curriculum. There was a wide range in length (average = 3 hours) and when present was almost always mandatory (n = 51, 88.2%). Few curricula mentioned labor (23.5%) or organ (5.9%) trafficking, or at-risk populations such as lesbian, gay, bisexual, trans, queer, and intersex (LGBTQI) members (13.7%), foreign nationals (7.8%), victims of political conflict (3.9%), and indigenous peoples (2.0%). Students and staff (n = 242) were from 34 states and 83 schools, and n = 36 (27.5%) reported a curriculum. Less than half (44.4%) felt the length (average 4.1 hours) was sufficient. Conclusions: Less than half of respondents reported an HT curriculum. It is unclear how well this curriculum prepares students to treat victim-survivors of HT. Future work is necessary to incorporate effective education on HT for trainees and evaluate patient outcomes after curricular implementation.

Operations research and analytics to combat human trafficking: A systematic review of academic literature

Human trafficking is a widespread and compound social, economic, and human rights issue occurring in every region of the world. While there have been an increasing number of anti-human trafficking studies from the Operations Research and Analytics domains in recent years, no systematic review of this literature currently exists. We fill this gap by providing a systematic literature review that identifies and classifies the body of Operations Research and Analytics research related to the anti-human trafficking domain, thereby illustrating the collective impact of the field to date. We classify 142 studies to identify current trends in methodologies, theoretical approaches, data sources, trafficking contexts, target regions, victim-survivor demographics, and focus within the well-established 4Ps principles. Using these findings, we discuss the extent to which the current literature aligns with the global demographics of human trafficking and identify existing research gaps to propose an agenda for Operations Research and Analytics researchers.

Confusing Terms: A Concept Analysis of Naming Youth Trafficking

Human trafficking is a growing population health problem. More than half of all persons experiencing trafficking are youth, with many in the United States unrecognized despite experiencing exploitation. Available peer-reviewed articles report a myriad of descriptions of trafficking, yet the concept and operational definition of youth trafficking, specifically, is lacking and unclear. Youth trafficking is described differently across multidisciplinary researchers and clinicians working with trafficked youth. Furthermore, labor trafficking of youth is largely excluded from the conversation surrounding trafficking. This article presents a concept analysis of naming trafficking of persons under the age of 18 years to clarify the concept specific to youth experiencing all forms of trafficking and approaches professionals can take with this specific subpopulation of trafficked persons and survivors.

Researching the Effectiveness of an Online Human Trafficking Awareness Program Among Community Health Nursing Students

PURPOSE

To evaluate the effectiveness of an online human trafficking awareness program for healthcare providers.

DESIGN

Mixed-methods study.

METHODS

Sample (N=141) consisted of community health nursing students, who completed a pretest, watched one three-minute video a day for 20 days, and completed a posttest.

FINDINGS

Participants indicated their knowledge of human trafficking increased, attitudes toward victims improved, and competence and confidence engaging with victims increased. Satisfaction with program, and information utilization plans for practice were revealed.

CONCLUSIONS

Human trafficking awareness program was effective in increasing participants' knowledge, competence and confidence, and improving attitudes.

CLINICAL EVIDENCE

Educational intervention is a strategy to improve students' knowledge of human trafficking.

Digital training in the wake of a pandemic: Using technology to train health care professionals in the identification of human trafficking victims

Human trafficking training is crucial for victim identification and appropriate service provision in health care settings. Over the past decade, the health care profession has made significant strides in the education and training of health professionals. However, access to quality training is still varied, and a unified education program has not been established. At best, educational programs are uneven in their goals and standards. Further complicating matters, amid the COVID-19 pandemic and social distancing regulations, in-person training has been less optimal. To provide all health care professionals with much-needed education on human trafficking identification and service provision, the authors recommend that human trafficking trainings incorporate online platforms and provide justification from the literature for this recommendation. The authors contend that virtual training programs provide easy access and provide a convenient platform for health care professionals to broaden their knowledge and awareness of the unique demands and challenges that trafficked persons encounter.

A Human Trafficking Educational Program and Point-of-Care Reference Tool for Pediatric Residents

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.

An Interprofessional Course on Trauma-Informed Care

BACKGROUND

Health care professionals need to recognize trauma exposure and provide trauma-informed care. There is a concomitant need to develop resilience when working in this context.

PROBLEM

We recognized the need to educate future health care professionals to provide trauma-informed care, develop resilience skills, and collaborate with other disciplines to provide this care.

APPROACH

We used a systematic instructional design process and an interprofessional approach to design and deliver the course. We utilized a range of resources and approached the course from micro, meso, and macro perspectives.

OUTCOMES

Through purposeful design, we developed a course that was well-aligned with our objectives. Assessments provided documentation that students achieved the learning outcomes.

CONCLUSIONS

The course educated future health care professionals on trauma-informed care. Students gained valuable experience that will help them contribute to interprofessional teams in the future. Students also practiced resilience techniques essential for health care professionals.

The Role of Nursing in the School Setting to Lead Efforts to Impact Child Trafficking: An Integrative Review

Registered professional and advanced practice nurses in the school setting, as a specialized practice entity, are leaders in implementation of evidence-based practice, skilled coordinators of care, advocates for students, and experts in designing systems assisting individuals and communities to reach full potential. Child trafficking (CT) is an emerging public health threat impacting safety and well-being of students present in the school setting. This literature review identified four themes in five studies: (1) training impacts nurses' knowledge, awareness, and attitudes; (2) school nursing is underrepresented in training, education, prevention, response, and research; (3) lack of collaboration exists between school staff and school nurses; and (4) formal education and length of experience impact levels of interventions school nurses are able to provide. School nurses are opportunely situated to intervene as advocates for vulnerable children to develop a coordinated, effective response to CT risk factors, mitigating risk and fostering resiliency with systems-based change.

The COVID-19 pandemic: Theoretical and practical perspectives on children, women and sex trafficking

We provide theoretical and practical perspectives on children, women, and sex trafficking during the COVID-19 pandemic. Process tracing is employed as a primary research instrument. It is an analytical technique used for either theory-building or theory-testing purposes that is employed to elucidate causation and change as well as to develop and evaluate extant theories in social sciences. We illustrate that a policy is needed that will strengthen the capacity of existing structures in the fight against the underlying trafficking so that these attendant structures are efficiently used to stop the trafficking and avoid the corresponding threats to public health safety.

Educating paediatric health-care providers about human trafficking

Human trafficking is a public health issue and humanitarian crisis. Most alarming is that children are especially at risk. Although many studies demonstrate that the majority of trafficked persons surveyed engage with the health-care system during the time in which they are trafficked, health-care practitioners lack the knowledge, tools and resources to assist these patients. The present efforts in training health-care professionals have been fragmented and largely ineffective. While prior training has produced short-term changes in knowledge or attitudes of health professionals, it has not produced sustained changes in knowledge and attitudes nor meaningful changes in screening or intervention. No training has demonstrated changes in patient outcomes. Trafficked persons, particularly children and survivors of labour trafficking, are inadequately served by our present training options for health-care practitioners, and evidence-based protocols are needed to care for this underserved, disenfranchised and traumatised population. To provide optimal care for trafficked youth, health-care practitioners may benefit from: (i) evaluating training for health care providers (HCP) rigorously and meaningfully; (ii) advocating for high-quality training for all HCPs; (iii) fostering partnerships with key stakeholders to inform training and practice; and (iv) designing HCP training that is comprehensive, spanning all forms of human trafficking and including all populations involved.