Transcription:

Andrew Wilner, MD (Host):  Human trafficking often seems like a far off crime in a movie that couldn't possibly be happening in our communities. However, it is more common in the United States than people realize. Today on Pediatrics In Practice, we have two experts from Children's Mercy, Kansas City to bring us up to date on the challenges of recognizing and reporting sexual exploitation and commercial sex trafficking.

I'm your host, Dr. Andrew Wilner. And I'd like to introduce my two guests from Children's Mercy, Kansas City. Rachel Whitfield is a nurse practitioner at the teen clinic. And Heidi Olson is the sexual assault nurse examiner, program manager. Welcome to both of you.

Rachel Whitfield, APRN, MSN, FNP=C (Guest): Thank you.

Andrew Wilner, MD (Host): Heidi. Let's start with you. How big a problem is human trafficking?

Heidi Olsen, MSN, RN, CPN, SANE-P Guest): That's a great question. And I think that's something that most people want to know. It's extremely hard to quantify because it's a crime. So, it's underground. A lot of victims do not self identify. Of course, traffickers are not gonna, you know, tell law enforcement how many people they're trafficking. So, it's very under reported and it's under-recognized. So I, can't throw out an accurate statistic because that doesn't exist. But what we know is that this problem is huge. So, just as healthcare workers, we know that about 88% of trafficking victims will come into contact with a healthcare provider while they're being trafficked. And we also know there's a very high demand to pay for sex in the United States.

The United States is actually the biggest consumer of sex in the world, currently. So, we know there are thousands of people wanting to pay for sex. Meaning thousands of people are probably, being trafficked and a lot of those people are also coming into contact with the healthcare settings. So, it's hard to give an exact number, but just kind of stepping back and looking at the entire issue, we know it's growing and that it's very prevalent. And even within our own hospital system, we are identifying more and more kids who are being exploited or trafficked every year.

Host: Rachel you work primarily with teenagers. Is this mostly a teenage problem?

Rachel Whitfield, APRN, MSN, FNP=C (Guest): No, it is not. What we're finding and Heidi can speak to this as well, is that while teenagers are at high risk for trafficking, the average age of entry into trafficking is debatable, but anywhere between the ages of 12 and 1., we know that kids are being trafficked much younger than that, oftentimes by their parents or caregivers or foster care providers. Because teens have more access to the internet and have a bit more freedom, they are at extremely high risk for being trafficked. And we do see a lot of teens who are at risk or actively being groomed for trafficking, but we do see people who are much younger being trafficked in our healthcare system as well.

Host: Well, I didn't realize that this was a pediatric problem. I guess it's something that pediatric physicians and emergency physicians should be more aware of. Are these people missed in routine visits?

Rachel: Absolutely. Oftentimes victims of trafficking do not self identify. And so they don't recognize that they're being trafficked, making it very hard for healthcare workers to identify them. Also, the media has sensationalized trafficking. So, as you mentioned in your opening statements, about the movies or TV sends this one message about trafficking, when in fact people are not being stolen from under their hostel in the foreign country or out of Ikea or Target. are being targeted in their everyday lives, on social media, at the mall where they hang out by friends of a friend or friends of a family member, and healthcare workers don't fully understand what trafficking looks like in the United States, and specifically with pediatric populations, making it very hard for them to identify trafficking.

Host: So what does trafficking look like?

Rachel Whitfield, APRN, MSN, FNP=C (Guest): So it, varies obviously with the age group that you're dealing with and in the pediatric population, oftentimes these kids look like normal kids. They present to us, especially in the teen clinic, outside of the emergency setting, like normal kids. And so what we really want to look for in the healthcare setting specifically with pediatric population are risk factors, history of abuse, more importantly, sexual abuse can likely be the number one indicator for a child who's at risk or being trafficked. Also homelessness, multiple sexual partners. Any type of physical trauma, can be a sign for a healthcare worker to look for. If they're having recurrent or clustered visits, frequent sexually transmitted diseases, things like that. Less likely they're going to have tattoos or brandings which is frequently talked about in the media. They're going to have a barcode tattoo or this branding of this specific burn. And oftentimes we are not seeing that in the healthcare setting.

Heidi: Yeah. I think that asking the right questions and looking at the psychosocial history of a child is really important because like Rachel said, I think historically we kind of thought of these as quote unquote juvenile delinquents or, a kid who's having behavioral issues or a kid who keeps coming in for STI testing. And why won't they use condoms when we're giving him these lectures? Instead of stepping back and looking at the big picture, which is, is this child being exploited? Are they being sold for sex? Are they in a situation that they can't leave? And I don't think that's historically been our mindset as healthcare providers.

And so, a, kid's not going to self identify, but if we can ask the right questions and there are screening tools that exist, which we've been using, it really starts to eliminate the red flags and just really show that maybe there is some potential of exploitation going on.

Host: Is there a easy screening tool to use? You know, everyone's always in a big hurry in every case setting these days. You can't sit somebody down for an hour, you know, and have them fill out a form. So, can you give me an example of a screening tool that an emergency room or a primary care physician could use?

Rachel: Yes, so there is a screening tool developed by a group of physicians in Atlanta that they have trialed both in emergency department settings and ambulatory and teen clinic settings. That it's quick for a screening tool, but it does take some time and it does require some follow up questions. We recently implemented it in our clinics and it adds about five to seven minutes onto the check-in process. But it opens up some really good conversation with teens about exploitation, sexual coercion, social media safety, unhealthy relationships, and healthy boundaries that maybe would not have come up otherwise during their visit. Heidi has been using this screening tool within her program for a few years now. And from what I hear, it's been very helpful with her patients as well with identifying trafficking. And that's more in the emergency room setting.

Host: So, the first step is to identify someone, either by their history and their examination or using this screening tool that raises your suspicion that, this person may be victim sexual trafficking. Well suppose I'm in the ER and I, and I get this sensation that, you know, I think I should look into that. It's like, well, what do I do?

Heidi: Yeah. That's a great question. And again, I think a lot of healthcare workers that's another big question is, so if I identify, then what on earth do I do with this information? So, there are several things that we would recommend. Obviously, you don't have to know for sure that your patient is being exploited or trafficked. You just have to have that suspicion. If it's with a kid, obviously we are mandated reporters. So, this is a type of abuse. We have to report it as so, so what we do is we hotline it's child protective services. And then also, obviously we think this child was a victim of a crime. We want to notify law enforcement. Because a lot of times, traffickers have more than one victim that they are trafficking. And this child is at great risk for being revictimized or continue to be exploited, if you know, this trafficker is not investigated. So, we report it to local law enforcement where the crime is occurring. We also report it to the human trafficking hotline, which is a huge resource for healthcare workers.

Even if, maybe you're not sure who also to call, you can call them and they can disseminate the information to different agencies all at once. We also notify the FBI and sometimes we notify the national center for missing and exploited children just to pull in multiple specialized agencies who understand exploitation and who understand trafficking. So, it's been really helpful to have a multi-disciplinary team. But you know, it may look different from healthcare setting to healthcare setting and who you report to.

Host: So, there really needs to be a protocol either in the physician's office or at the hospital, clinic, or ER, is once a suspicion is raised, then a certain numbers have to be called and forms filled out. Is that what you recommend?

Heidi: Absolutely. I think to start screening, but not having a protocol in place, that's going to create massive chaos, and frustrations. And so I think having a protocol in place first and then to start screening and start to consider, you know, what are we going to do when we identify victims? It makes a lot more sense and will probably go a lot smoother when patients are identified as being exploited.

Host: Do you have that human trafficking hotline number handy? I think our listeners might find that very useful.

Rachel: Sure. It's 888-  

And there's also a text line where you can text help or info to 233 733. And reports can also be placed online at humantraffickinghotline.org.

Host: Oh that's, very helpful. As I've been listening to this discussion, I'm trying to image in my mind and I'm wondering, does this affect boys as well as girls?

Heidi: It does. And we have identified males who are being trafficked. We've also identified transgender youth who are being trafficked as well. Boys and I think just gender minorities in general, coming through the healthcare setting, don't identify as readily as females do. I think there was a lot of shame and, you know, other factors that go into it where they don't maybe feel as comfortable telling us the details that maybe some female patients will. So, we know boys are being trafficked. We've definitely seen it and identified it but we don't have as much data on it.

Host: So, emergency medicine specialists and primary care doctors really have to be aware for both boys and girls that this could be a problem.

Heidi: Yes.

Host: I would like to thank my guests, Rachel Whitfield and Heidi Olson. This discussion has raised awareness of the problem of human trafficking a little higher on everyone's radar. This has been Pediatrics In Practice with Children's Mercy, Kansas City. To refer your patient or for more information, please visit children'smercy.org to get connected with one of our providers. Emergency medicine specialists, and first responders can get more practical tips by visiting children's mercy.org/EMS.

Please remember to subscribe, rate, and review this podcast and all the other Children's Mercy podcasts. I'm your host, Dr. Andrew Wilner. Thanks for listening.