For Healthcare Professionals

Healthcare and Child Sex Trafficking

Healthcare is a critical arena in which sex trafficking and sexual exploitation intersect with identification and intervention of victims.  Polaris (2017) estimates that 69% of trafficked survivors in the U.S. had access to healthcare at some point during their exploitation, and 85% received treatment for illness or injury directly related to their work or exploitation.  More specifically, Lederer and Wetzel (2014) found that 87.8% of their sex-trafficked survivor subjects had contact with healthcare during their victimization.  While the ER received the largest percentage of sex-trafficked survivors, victims present to a variety of healthcare locations, including women’s health, primary care, mental health, substance abuse facilities, dental, pediatrics, urgent cares, community clinics, planned parenthood, and many specialties.  

Knowing that only a small fraction of sex-trafficked victims are even identified, we can extrapolate to the conclusion that the numbers that present to our healthcare facilities are even higher.  Those who work in healthcare, given the training to be able to identify victims of sexual exploitation and respond appropriately, can make an enormous impact on the lives of the vulnerable and invisible who pass before our very eyes.

Environmental Indicators

·  Controlling individual with the patient – This individual may identify as a parent, family member, guardian or caretaker.  They may speak for the patient/over the patient and control the situation. They may decline an interpreter if a different language is spoken by the patient.

·  Patient appears to be lying about their age – Often, they will say they are older than they are.

·  Wearing inappropriate clothing for the weather, such as long sleeves in the hot summer.

·  Lacks a fixed address, unsure of address, or “just visiting”

·  No insurance, paying cash

·  Arrival of multiple teens with one adult. These multiple teens may also ask for medical care or treatment.

·  Minor with hotel keys, multiple cell phones

·  Minor has expensive clothing or accessories which may seem incongruent to the rest of their presentation

·  Older significant other, “boyfriend”

 Behavioral Indicators

·  Refusing appropriate care without explanation, leaving AMA

·  Scripted or inconsistent history, changing information

·  Hesitant and submissive, especially with the presence of a controlling person

·  Injuries inconsistent with history

·  Protecting the person who hurts them, minimizing abuse

·  Overly fearful or nervous, lack of eye contact

·  Hostile, “difficult” patient

·  Unaware of time, location

·  Use of language of the sex trade – for example, “daddy” “trick” “the life”

·  Change in behavior, decrease in grades, truancy, school problems

·  Sexualized behavior – sexual knowledge/behavior inappropriate to developmental age

·  Intoxication

·  Acute change in mental health

·  Signs of post-traumatic stress, anxiety, depression

 Physical Indicators

·  Delayed care or untreated chronic conditions

·  Bruising, burns, injuries in various stages of healing

·  Physical and sexual abuse

·  Malnourishment

·  Poor hygiene

·  Substance use/abuse

·  Significant dental problems

·  Multiple pregnancies, abortions

·  Frequent sexually transmitted disease testing or treatment

·  Traumatic injuries

·  Somatic manifestations of stress

·  Injuries inconsistent with history

·  Patterned scars

·  Tattoos – These are often used as branding by the trafficker. These may be initials, sexually explicit, and the patient may be reluctant to explain them

·  Evidence of sexual trauma

·  Evidence of a botched abortion

Reclaim13 partners with hospitals and healthcare professionals to provide for the specialized medical needs of survivors of child sexual abuse and exploitation