221 - Healthcare Utilization of Victims of Commercial Sexual Exploitation Compared to Non-victims

Poster Number: 221
Publication Number: 221.401

Cree Kachelski, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; James Anderst, Children's Mercy Hospital, KANSAS CITY, MO, United States; Mary Moffatt, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; Jennifer Hansen, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; Ashley K. Sherman, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; Grace E. Arends, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; Heidi Olson, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; Rachel M. Whitfield, Children's Mercy Hospital, Raymore, MO, United States

Background: Approximately 17,000 US children are victims of Commercial Sexual Exploitation of Children (CSEC) annually.Nearly 75% of adolescent CSEC victims received medical care within 6 months prior to identification.Screening tools have been developed based on known characteristics of CSEC victims; however, little is known about how CSEC victims compare to non-CSEC adolescents in healthcare utilization.Thus, appropriate medical CSEC screening settings are unknown.

Objective: We aimed to identify where and how often adolescents presented to medical care in the 12 months prior to CSEC identification.We hypothesized that compared to controls, CSEC-positive adolescents would present to medical care less frequently and would obtain a greater proportion of medical care in an acute care setting and for reproductive and mental health issues.

Design/Methods: A retrospective case-control study was conducted at a large pediatric hospital system during a period of 46 months.Cases included adolescents aged 12-18 years who screened high-risk/positive for CSEC. Control group 1 included adolescents with a history of child maltreatment who screened low-risk/negative for CSEC.Control group 2 were adolescents with no history of maltreatment and no CSEC screening, matched to cases and to control group 1 on demographics and date seen.The three study groups were compared for frequency,location of medical care, and diagnosis given.

Results: There were 119 CSEC-positive adolescents, 310 CSEC-negative, and 429 adolescents with no abuse history.CSEC-positive adolescents sought care more frequently than CSEC-negative and control adolescents (median 2 visits/subject [IQR 1-3]; 1 visit/subject [IQR 1-2], p=0.03; 2 visits/subject [IQR 1-2], p=0.01).CSEC-positive adolescents were more likely to have sought care in an acute care setting (51.8%;43.0%;46.8%, p < 0.0001) and more commonly for inflicted injuries (8%;3.6%;1%, p=0.0001), mental health concerns (36.9%;16.2%;3.8%, p < 0.0001), and reproductive health concerns (10.8%;4%;4.3%, p=0.003).In primary care locations, CSEC-positive adolescents were more commonly seen for reproductive health (59.3%;27.5%;34.5%, p=0.002) and mental health concerns (13%;29.4%;8.6%, p =0.006).Conclusion(s): High-risk/positive CSEC adolescents seek medical care more frequently than non-victims. As compared to non-victims, CSEC victims more commonly seek care in acute care settings for mental and reproductive health and inflicted injuries. In primary care settings, CSEC victims more commonly present for reproductive healthcare. These data may be used to better target screening for CSEC.