Training Experiences of Emergency Department Providers in the Recognition of Child Trafficking.

OBJECTIVE: Trafficked children face challenges to obtaining appropriate health care that may be addressed by clinician training. We evaluated emergency department (ED) staff's training experiences regarding child trafficking and attitudes toward educational efforts to provide informed recommendations for improvement in the recognition and evaluation of trafficked children in the ED setting. METHODS: In this cross-sectional study of general and pediatric ED staff across 6 cities in the United States, participants completed a 25-question, online anonymous survey. Differences in proportions between categorical data were examined using χ2/Fisher exact tests. Differences in means were evaluated using Student t test and 1-way analysis of variance. RESULTS: The 484 participants included physicians (33.0%), nurses (27.4%), resident physicians (12.2%), and social workers (10.1%). Only 12.4% reported being very confident in recognizing child trafficking. Barriers to recognition included lack of awareness and training on child sex trafficking (37.4%, 58.3%) and labor trafficking (38.4%, 50.6%), sensitivity of the topic (44.4%), lack of institutional guidelines (29.8%) and social work coverage (26.0%), and the assumption that children will not disclose victimization (16.5%). Although 62.2% of the respondents had prior training in child sex trafficking, only 13.3% reported that it was adequate. Barriers to training included lack of easy access (82.5%), belief that prior training was adequate (13.3%), poor-quality curricula (5.1%), and low priority of topic (4.1%). Recommendations for training included a 1-hour module/webinar/lecture (43.1%), rounds (40.5%), written guidelines (9.8%), and individualized, case-based learning (6.6%). CONCLUSIONS: We found that although most ED providers stated that they had prior training in the recognition of child trafficking, few expressed confidence in their ability to recognize and evaluate trafficked children. Barriers to education included a lack of awareness of and access to available curricula. Providers supported a variety of formats for further education. Strategies for improving educational access are discussed.

Development of a screening tool for pediatric sexual assault may reduce emergency-department visits.

OBJECTIVE: To define the characteristics of a novel screening tool used to identify which prepubertal children should potentially receive an initial evaluation for alleged sexual assault in a nonemergent setting. METHODS: Electronic medical records were retrospectively reviewed from 2007 to 2008. Visits with a chief complaint or diagnosis of alleged sexual assault for patients aged 12 years or younger were identified. Complete records, those with no evaluation before pediatric emergency-department arrival, and those with child advocacy center follow-up were included. Records were reviewed to answer the following: (1) Did the incident occur in the past 72 hours, and was there oral or genital to genital/anal contact? (2) Was genital or rectal pain, bleeding, discharge, or injury present? (3) Was there concern for the child's safety? (4) Was an unrelated emergency medical condition present? An affirmative response to any of the questions was considered a positive screen (warranting immediate evaluation); all others were considered negative screens. Those who had positive physical examination findings of anogenital trauma or infection, a change in custody, or an emergency medical condition were defined as high risk (having a positive outcome). RESULTS: A total of 163 cases met study criteria; 90 of 163 (55%) patients had positive screens and 73 of 163 (45%) had negative screens. No patients with negative screens were classified as high risk. The screening tool has sensitivity of 100% (95% confidence interval: 93.5-100.0). CONCLUSIONS: This screening tool may be effective for determining which children do not require emergency-department evaluation for alleged sexual assault.