PC2050: Attachment Trauma and Mental Healthcare Access, Recidivism, and Outcomes Among Adolescent Human Trafficking Survivors Treated in the Acute Care Setting While Awaiting Mental Healthcare Services

Background: We launched a human trafficking hospital-based response team to provide screening, assessment, physical and mental healthcare navigation, missed preventative healthcare, STI and pregnancy screening, criminal justice advocacy, and community service provider hand-offs to adolescent victims of human trafficking identified in the healthcare setting. Recidivism, relapse, and low survivor engagement in restorative care are known barriers to sustained recovery from exploitation and survival crime. We examined patterns of attachment trauma including parental loss, competing household needs, and parent child relationship dysfunction and hospital lengths of stay, recidivism, and barriers to residential mental health treatment.

Methods: This is a retrospective, observational cohort study of adolescents impacted by human trafficking and managed in the acute care setting while awaiting mental healthcare services. This formative data is from a program based in an urban, tertiary care children’s hospital between March 2019 and March 2022. We analyzed descriptive data and examined hospital lengths of stay, recidivism, and outcomes among the adolescent cases to understand barriers to treatment and unique attachment trauma and family dysfunction that impacts the needs of this population.

Results: We provided consultation on 110 patients ages 9 years to 17 years and participated in the acute care navigation of 46 confirmed cases of human trafficking (44 sex trafficking, 1 labor trafficking, 1 sex and labor) and 1 case of a male patient dealing with the aftermath of a parent's trafficking experience. Racial demographics as follows; 66% black, 26% Caucasian, 4% Hispanic, 2% Asian and 2% declined. 47 adolescents were treated in 93 hospitalizations with a median length of stay of 48 days and total hospital treatment days of 2528. 94% of the cases were female (43), 2% or one case was a transgender female, and 6% or 3 cases were male. Figure One captures overall hospital utilization, cumulative hospital days by recidivism, and 7 cases with multiple hospital stays and/or LOS >100 days, age, and barriers to accessing residential treatment. Figure Two shows patterns of parental loss, complex, competing household needs and guardianship patterns. Patients with recurrent elopement, aggression as the primary trauma symptom, and parental interference with treatment had the highest recidivism and barriers to accessing treatment options.

Conclusion: Access to residential mental health treatment for adolescent human trafficking survivors with attachment trauma, trauma symptoms of aggression, and ongoing parental interference in treatment is difficult and the current hospital response program of intensive relational support, healthcare navigation, and case management did not facilitate improved access to mental healthcare for attachment trauma.