P0220 - Barriers and Facilitators to Recognition of Child Trafficking in Emergency Departments

Background: Children who are victims of sex or labor trafficking may seek medical care in Emergency Departments (EDs). We sought to determine barriers and facilitators to recognition by ED providers of such children when they present for emergency care.

Methods
This was a cross-sectional study. A voluntary, online, anonymous survey was sent to Emergency Department providers at academic institutions in Portland OR (CARES Northwest), St. Louis, MO (Washington University School of Medicine), Rochester MN (Mayo Clinic), Atlanta GA (Emory School of Medicine) and New Haven CT (Yale School of Medicine). The survey (Qualtrics Survey Software, Yale University) consisted of 25 questions and was iteratively revised by two of the study authors (KB, VJG). The study period was from September 1, 2019, to February 29, 2020.

Results: There were 481 responses to the survey. The majority of respondents were attending physicians (33%), nurses (27%), post-graduate trainees (residents) (12.3%), and social workers (10.2%). The majority of respondents were female (71.1%). Geographic regions included MN (25.8%), MO (23.5%), GA (11.4%), HI (8.9%), NY (4%) CT (3.5%) and OR (3.1%). 40.8% of respondents worked in an academic, urban ED. The mean proportion of patients younger than 18 years old in these EDs was 70%.

Only 8.7`% of respondents reported being very confident in recognizing child trafficking. Barriers to recognition included the following: lack of training on sex trafficking (58.6%) and labor trafficking (50.9%); lack of awareness of child sex trafficking (37.6%) and labor trafficking (38.7%); the fact that child sex trafficking and labor trafficking are difficult subjects (44.7%); a lack of institutional guidelines (29.9%) and lack of social work coverage (26.2%).

Only 13.9% reported using a screening tool to identify trafficked children. Barriers to using a screening tool included: (it) takes too much time (30%); not enough training on trafficking to use it (17.1%); (it) is not convenient or feasible (11.5%); not comfortable (with screening tool) (3.2%); multiple factors, such as the patient will not disclose, there are no resources for the patient (17.1%). The remainder of respondents (21.1%) were not familiar with any screening tool.

While 62.2% of respondents had any prior training in child trafficking, only 10.8% reported it was adequate. Of those who had no training, the majority reported either a grand rounds (40.5%) or a 1-hour module/webinar (38.7%) on the topic of child trafficking would be most beneficial.

Conclusions: ED providers from a wide range of geographic locations report low confidence in recognizing victims of child sex or labor trafficking, which could be addressed by providing training in the form of grand rounds or online modules/webinars. Further study of the utility of such interventions to address this lack of confidence is needed.