Texas Health and Human Services / Texas Health Steps

Identifying Patients Experiencing Trafficking and Exploitation

Children and adolescents who experience sex and labor trafficking and exploitation may seek health care in a variety of settings, such as emergency departments, community clinics and private practices. That makes it “essential that pediatric providers anywhere are equipped to recognize potential T/E [trafficking and exploitation] and respond appropriately.

American Academy of Pediatrics (AAP), 2023

The role of the pediatric healthcare provider includes advocating for the rights of children and adolescents. Child trafficking and exploitation are violations of basic human rights and can result in serious physical and mental harms.

Children and adolescents can be disproportionately vulnerable to trafficking and exploitation (Chang et al., 2022).

  • Their neurobiology has not developed enough for them to effectively assess risk.

  • They have fewer life experiences that could warn them away from the psychological manipulation used by traffickers and exploiters.

  • Adolescents may be more impulsive because of brain reward circuits that can act to encourage experimental and risky behaviors, especially when the youth use substances or alcohol.

Although healthcare providers are not charged with eliminating child trafficking and exploitation, they are on the front lines for identifying children and adolescents who have been victimized or are at risk for victimization.

Key Risk Factors and Vulnerabilities for Being Trafficked and Exploited

  • Recent migration/relocation
  • Mental or physical health concern
  • Substance use concern
  • Unstable housing
  • Runaway/homeless youth

A Clinical Case Scenario

Angie 15 years

Angie, who is 15, presents to a clinic with complaints of abdominal pain, nausea and vomiting. She is accompanied by an adult who identifies herself as Angie’s sister. The provider has a hard time getting a clear history because Angie is not forthcoming with her sister in the room.

During the private interview, the provider learns that Angie has become sexually active yet uses no contraception, and only her sister knows that. Angie appears uncomfortable responding to questions about sexual activity but denies being unsafe. When asked about school, Angie reports she has not attended for some time.

When the sister returns to the exam room, she says Angie lives with her now and hasn’t been in school because of moving between houses. She reminds the provider they only want help with Angie’s stomach issues. Some details of the case don’t add up. They present red flags for risk in Angie’s behavior and life situation.

Identifying and caring for children and adolescents at risk for trafficking and exploitation requires trauma-informed practices, such as creating a safe environment and building trust. The provider must address the patient’s presenting condition first. In this case, the provider helps Angie with her stomach issues.

The next steps to take:

  • Screen for and treat any sexually transmitted infections.
  • Share information about safe sex practices and contraception.
  • Further assess for Angie’s safety.

Is Angie Experiencing Trafficking?

Individuals who are experiencing trafficking or exploitation may not be willing, ready or able to disclose specifics about their situation or their safety.

In addition, people being trafficked “will not always or even often identify as trafficking victims,” according to a nonprofit organization that combats trafficking (Polaris, 2023). “Because of how trafficking works, most people do not identify their experience as trafficking until AFTER the situation is over.”

That may feel frustrating for a provider who wants to help. The healthcare provider can:

  • Stay tuned to red flags and nonverbal cues
  • Use specialized screening tools, when indicated
  • Appropriately document concerns and a plan of action

You may encounter situations that are not clear presentations of trafficking. You can help protect your patients by having privacy protocols, easily accessible screening tools and a plan for urgent and nonurgent referrals to local and national resources if you suspect risk or identify trafficking.

Why It Matters

Healthcare providers must be prepared to care for children and adolescents who are at risk for or are experiencing trafficking and exploitation. Providers can make a meaningful difference by developing and improving their clinical and personal skills and preparing their practice to identify individuals who may be experiencing trafficking and exploitation. That may include recognizing incidences of possible trafficking and exploitation and saying, “I’m here. I care. I can help you.”

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References

Chang, K. S. G., Tsang, S., & Chisolm-Straker, M. (2022). Child trafficking and exploitation: Historical roots, preventive policies, and the Pediatrician’s role.Current Problems in Pediatric and Adolescent Health Care, 52(3), [101167].

Greenbaum, J., Kaplan, D., Young, J., et al.; AAP Council on Child Abuse and Neglect, AAP Council on Immigrant Child and Family Health. (2023). Exploitation, Labor and Sex Trafficking of Children and Adolescents: Health Care Needs of Patients. Pediatrics, 151(1):e2022060416

Polaris. (2023). Understanding Human Trafficking: The Narrative Arc.