Pediatric Resident Akron Children's Hospital Akron, Ohio, United States
Background: Child sexual trafficking (CST) affects adolescents in the United States at alarming rates, yet its prevalence is often locally underestimated by health care providers. In a nationally representative sample of US adolescents, 4.9% reported transactional sex. Hornor et al. found up to 82.5% of CST victims had contact with medical professionals while trafficked. Emergency departments are the most frequently reported medical location for individuals to access medical care. Understanding risk factors associated with CST is essential to increase the identification of victims at medical centers. Greenbaum developed a 6-question CST screen; a threshold of 3 or more positive responses has been shown to have a sensitivity of 81.8% and a specificity of 75.5%.
Objective: To pilot the CST Screen in a high-volume, tertiary-care pediatric emergency room to optimize screening adoption and assess positivity rate within a high-risk population.
Design/Methods: The CST screen was administered to a convenience sample of adolescents presenting for alleged sexual assault, behavioral health assessment, and other high-risk chief complaints at two pediatric ERs in Northeast Ohio from May-Nov 2021. A positive screen was defined as an affirmative, relevant answer to 3 or more answers. Social workers were consulted for positive screens with additional clarifying questions asked and outpatient resources for follow-up provided when CST was identified in the social work interview. Logistic regression was used to assess factors associated with positive CST screens.
Results: Data were collected from 119 patients presenting to the ED. 57.6% of screened patients presented for behavioral health assessment, 6% for alleged sexual abuse (SCAN), and 36.4% for high-risk chief complaints (HRCC), such as sexually transmitted infection testing. Positive screening was associated with increased age and HRCC. Most notably, our convenience sample demonstrated a positivity rate of 21% among all screened adolescents. An alarming 42% of HRCC screened positive along with 14.3% of SCAN patients.Conclusion(s): Our project suggests that CST screening in settings serving adolescents with high-risk behaviors is a high-yield endeavor that reveals dramatic positivity rates. This intervention also catalyzes conversations between adolescents and medical providers to educate patients about the dangers of specific in-person and online practices. More data is needed to determine the effect that broader screening can have for victims of, and children at risk for, CST. CV 2021, Dade.pdf Table 2: Percentage of CST Screens Positive by Age
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