Missed opportunities to screen for sexual exploitation among youth who have experienced sex trafficking

Sex trafficking and sexual exploitation (SE) of youth remain pervasive but underrecognized crimes in the US. Most youth who experience SE interact with healthcare during their exploitation but many are not recognized. To identify opportunities to strengthen care for youth at risk of SE, we examined the frequency and predictors of youth being screened for SE and receiving other elements of best practice adolescent healthcare in the year prior to their intake at a specialty clinic for sex-trafficked youth. We conducted a retrospective chart review of patients seen for an intake appointment between July 2021-October 2022 at this specialty clinic. We evaluated past-year healthcare visit locations, reasons for visits, screening for SE, and provision of three elements of guideline-compliant adolescent care: confidential conversation with a provider, sexually transmitted infection testing, and social work referral when indicated. We used comparative statistics to evaluate associations with screening for SE, and logistic regression to evaluate the association between SE, guideline-compliant care and prior healthcare visit location. Of the 31 included patients, 87% (n=27) had at least one prior-year healthcare visit, corresponding to 102 visits. The most common visit location was the Emergency Department (ED) and the most common reasons for visits were reproductive health/STI testing and injury/assault. During at least one prior-year healthcare visit, 56% of youth (n=15/27) had documented screening for SE and 56% (n=15/27) received all three elements of guideline-compliant care. Youth who received any of the three elements of guideline-compliant care were more likely to be screened for SE, as were youth who were admitted to the hospital. Despite frequent healthcare utilization, many youth with histories of sexual exploitation did not receive guideline-compliant adolescent care or screening for SE. Embedding trauma-informed adolescent care into routine healthcare practice may improve recognition and support for this population. Looking ahead, it is critical for health systems to develop protocols and trainings to support providers in appropriately identifying and supporting youth with histories of SE. Highlights : • Most youth at a trafficking clinic had a prior-year healthcare visit, often in an ED • Almost half were not screened for sexual exploitation during any prior-year visit • Only 56% received all elements of guideline-compliant adolescent care • Guideline-compliant care was strongly associated with SE screening • Improved institutional policies and provider trainings may increase SE recognition