Abstract
This chapter aims to describe the role of the pediatric healthcare system in the prevention and identification of children and youth who are trafficked, and what the pediatric healthcare response should entail. To help providers understand the relevance of this work, the authors provide a detailed context for trafficking in children, specifically with regards to risk factors, special populations, vulnerabilities, and healthcare interactions, and then delve into an exploration of the evidence base describing pediatric health care provider knowledge, studied interventions, screening tools and strategies, and the pediatric provider response. Summary tables and case vignettes are included to provide the reader with helpful quick references.
TopIntroduction
The pediatric health care system has an important role in the prevention and identification of child trafficking, and the response to survivors of child trafficking. The field of pediatric medicine encompasses not just physical and mental health, but the social and public health of children. This means that pediatric health care providers are uniquely equipped to participate in the multidisciplinary approach necessary to counter child trafficking. This chapter will focus specifically on child and youth trafficking within the United States (U.S.), including minors less than 18 years of age, and youth up to 21 years of age. This chapter will discuss:
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Epidemiology and trafficking background information
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The intersection of pediatric health care and child trafficking survivors
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Special populations and risk factors
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Health care outcomes of child trafficking survivors
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Addressing prevention and detection
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The health care provider response
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Solutions and recommendations
TopBackground: Epidemiology And Context
While accurate statistics remain elusive due to the nature of trafficking, according to the International Labour Organization, 5.5 million children were trafficked globally for sex and labor between 2002 and 2011 (International Labour Organization, 2017). Data from the National Human Trafficking Hotline indicate that child sex and labor trafficking occur in every state in the United States (National Human Trafficking Hotline, 2020). The most recent 2021 annual Trafficking in Persons Report published by the U.S. Department of State revealed that there were 11,100 trafficking victims and 626 labor trafficking victims identified in the Western Hemisphere in 2020 (US Department of State, 2021).
Child Sex Trafficking (CST)
Research indicates that buyers seeking sex target children; therefore, pediatric providers are key in education and prevention. A language analysis of a popular internet website forum found that buyers frequently mentioned a desire for youthfulness, awareness of the vulnerability associated with young age, and the presence of a third-party pimp in seeking sexual encounters with youth or children (Bounds et al., 2020). The usage of the internet and social media has also been well-documented. A study of homeless youth trafficking survivors showed that 70% of them reported technology usage in trafficking, including: Backpage, Facebook, Snapchat, porn, dating websites, Craigslist, Twitter, Instagram, Tumblr, Paypal, Bitcoin, Tinder (Middleton et al., 2018).
During the COVID-19 pandemic that began in 2020, preliminary data revealed concerning increases in child abuse and trafficking due to increased time that children spent online, reduction in time children spent around mandated reporters such as teachers and health care workers, and increased usage of the internet by predators, buyers, and traffickers (Greenbaum et al., 2020; US Department of State, 2021).
Pediatric providers should remain aware of the dangers of internet websites, apps, and other technology-based recruitment tactics, and provide appropriate social media and internet anticipatory guidance. The American Academy of Pediatrics (AAP) has provided several useful policies and statements that providers may reference (Hill, 2020).
Key Terms in this Chapter
Sex Trafficking: According to the Trafficking Victims Protection Act of 2000, trafficking is a commercial sex act induced by force, fraud, or coercion, or in which the person induced to perform such act has not attained 18 years of age.
Labor Trafficking: According to the Trafficking Victims Protection Act of 2000, labor trafficking is the recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery.
Adverse Childhood Experience (ACE): Potentially traumatic events occurring in childhood that may lead to chronic health problems, mental health issues, and other challenges that may persist to adulthood. They are categorized into abuse (physical, emotional, and sexual), household challenges (e.g., substance abuse, mental illness, parental separation or divorce, incarcerated household member), and neglect (physical and emotional).
Healthcare Provider: Any professional who is involved in providing health care to patients, including but not limited to nurses, advanced practice providers, physicians, therapists.
Child Trafficking: Human trafficking (labor or sex trafficking, as defined below) involving someone who is less than 18 years of age.
Sexually Transmitted Infection (STI): An infection that is transmitted sexually. For example, gonorrhea, chlamydia, HIV, or syphilis.
Trauma-Informed Care: An approach to caring for a patient that recognizes the role trauma may play in that person’s life, and how it may affect their tolerances and responses to various treatments and settings. It is an approach that requires the provider to be sensitive to and cognizant of the way the provider speaks, interacts with, examines, and assists the patient.