365 - Operationalizing Child Sex Trafficking Screening in an Academic Emergency Department

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 365
Publication Number: 365.404

Kevin McConkey, Levine Children's Hospital, Charlotte, NC, United States; Elizabeth J. Boyle, SSM Health, Madison, WI, United States; Amanda Palm, University of Wisconsin American Family Children's Hospital, Madison, WI, United States; Lauren A. Holzhueter, American Family Children's Hospital, Madison, WI, United States; Jessica Wipperfurth, American Family Children's Hospital, Madison, WI, United States; Jens Eickhoff, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Ryan E. Tsuchida, University of Wisc, Madison, WI, United States; Daniel R. Rutz, University of Wisconsin, Madison, WI, United States; Collin Michels, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Ciara Barclay-Buchanan, University of Wisconsin, Madison, WI, United States; Joshua Gauger, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Josh Glazer, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Irene Hurst, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States

Presenting Author(s)

Irene Hurst, MD, MS (she/her/hers)

Assistant Professor, Medical Director of Pediatric Emergency Medicine
University of Wisconsin School of Medicine and Public Health
Madison, Wisconsin, United States

Background: Child sex trafficking is a pervasive issue throughout the United States. There are multiple screening tools available to aid in detection and the Emergency Department (ED) is often where these patients present for care.

Objective: In this study, an electronic, confidential child sex trafficking screening tool was operationalized in an academic Pediatric ED where screening was not previously implemented.

Design/Methods: Screening was performed in 12 to 17-year-old high-risk patients using a previously validated electronic, confidential screening tool in a Midwestern academic ED with approximately 17,000 pediatric annual visits. ED research coordinators screened patients over 15-hours per day. High-risk patients were identified by specific chief complaints (psychiatric, genitourinary, or trauma) or provider concern for exploitation. Data collection began in March 2022. Interventions to improve screening adherence were tracked over time. Multiple reminders were placed throughout the Emergency Department (posters, badge backers – Image 1) with informational QR codes for patients and staff. Direct text messages were sent to providers when a positive screen was identified. A positive screen was considered ≥ 2 positive questions, and true positive status was determined by a social work evaluation. During screening, prior trafficked patients were identified that were now in safe situations. An additional provider survey question was added to elucidate this patient population.

Results: 212 patients have been screened to date. 92 patients were excluded due to incomplete patient surveys, social work assessments, or provider surveys. The prevalence of child sex trafficking of screened patients was 6% (95% CI: 3-12%, n=7). Two additional patients had been trafficked prior with a positive screen that had not yet been reported to law enforcement, but were not being currently trafficked on further assessment. Frequent reminders to providers via email, text message, and faculty meeting presentations were completed, but did not change the rate of true positive identifications. 8% of patients did not have confirmatory screening done by social work prompted by providers (n=15), and 13 of these patients had a positive screening tool.

Conclusion(s):

We demonstrated the feasibility and generalizability of introducing a previously described child sex trafficking screening tool in a new clinical environment. We identified a similar prevalence of sex trafficking reported elsewhere in the US. Continued improvement opportunity exists to increase confirmatory social work assessments on patients with positive screens.
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