The Trafficking Victims Protection Act of 2000 defines sex trafficking as “a commercial sex act induced by force, fraud, or coercion.” It further specifies that a minor who performs a commercial sex act is considered a victim of human trafficking, regardless of whether force, fraud or coercion was used.

Minors who have experienced child maltreatment, interpersonal violence, sexual assault or community and/or gang violence are at increased risk for sex trafficking, as are runaway and homeless youths, those in or who have been in foster care, and those who have been in the juvenile justice system.

Often, a health care provider is one of the few professionals who interact with these individuals. One study reported that nearly 88% of the interviewed survivors of domestic sex trafficking had been seen by one or more health care professionals while they were being trafficked (Lederer L, Wetzel C. Annals of Health Law. 2014;23:61-91).

AAP priorities to combat sex trafficking include education of pediatricians, legislative advocacy and more resources for intervention services. An AAP clinical report provides guidance for pediatricians on recognizing the signs/symptoms of child trafficking and sexual exploitation (https://pediatrics.aappublications.org/content/135/3/566). It also outlines major issues regarding public policy, medical education, research and collaboration in the area of child labor and sex trafficking, and provides, recommendations for future work.

Legal complexities can make identifying and reporting victims of child sex trafficking confusing.

Although every state includes sexual abuse or sexual exploitation in its definition of reportable child abuse and neglect, variations occur in how abuse is defined; whether reports are made to child welfare, law enforcement or both; which types of abuse are reportable; and whether sexual abuse by third parties (i.e., not a parent or guardian) is reportable.

A recent amendment to the federal Child Abuse Prevention and Treatment Act specifies that “a child shall be considered a victim of ‘child abuse and neglect’ and of ‘sexual abuse’ if the child is identified … as being a victim of sex trafficking … or a victim of severe forms of trafficking in persons” as described in the Trafficking Victims Protection Act. It gives the option to treat young adults up to age 24 as victims of “child abuse and neglect” or “sexual abuse.”

Sometimes, health care providers or administrators are unsure of how the Health Insurance Portability and Accountability Act (HIPAA) affects mandated reporting. In short, HIPAA rules do not apply where the “provision of state law … provides for the reporting of disease or injury, child abuse, birth, or death, or for the conduct of public health surveillance, investigation or intervention” (Section 160.203[c]) or where state laws are more stringent than HIPAA rules. Mandated reporting must be made only to the legal entity authorized to receive these reports, and only the information required under mandated reporting laws should be disclosed.

Important reminders

• Keeping the patient safe is paramount, as is using a trauma-informed, culturally sensitive approach.
• Know and follow your state’s mandatory reporting requirements.
• Never confront a suspected trafficker or otherwise put the patient, your staff or yourself in danger.
• In situations of immediate, life-threatening danger, report to law enforcement or follow your organization’s protocol for summoning security or involving law enforcement.
• Some EDs use an alias in place of the patient’s name to protect the victim from retaliation while in the ED.
• Document the patient’s injuries and treatment in the medical record.
• Record the activities the patient reported he or she was required to perform; avoid pejorative terms like “prostitute” or “drug dealer.”
• Use patient quotes as much as possible. Paraphrase or summarize with great care and accuracy.
• If there is evidence of physical harm and photographs are used (with patient consent), document who took the photos and that the “photos are both accurate and unaltered.”
• Use resources from the National Human Trafficking Resource Center (https://humantraffickinghotline.org/) to be guided through a trafficking screening interview and to identify services for people who are trafficked when a protocol is not in place.

The police department, child protective services and social work are notified, and your patient is rescued from human trafficking. She is reunited with her family and is receiving multidisciplinary trauma-informed care necessary for her healing and recovery.

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