Perceptions of trauma-informed care: the experiences of minor sex trafficking survivors in medical settings

Many survivors who experienced sex trafficking as minors have contact with emergency medicine providers during their exploitation. Trafficking survivors often arrive in emergency medicine settings with complex trauma histories, which can impact their decision-making about how and whether to seek support. Trauma-informed practices, policies, and procedures can help clinicians safely and appropriately respond to the healthcare needs these patients. Yet, there is little evidence about how individuals who experienced sex trafficking as minors actually perceive trauma-informed care in healthcare settings. This qualitative study explores (1) how individuals who experienced sex trafficking as minors perceive trauma-informed care in healthcare settings, and (2) patterns in perceptions of trauma-informed care in health care before, during, and after survivors’ experiences with exploitation. Semi-structured interviews were conducted with 35 adult survivors of sex trafficking as minors. The interview protocol was designed to understand participants’ experiences with health and healthcare through three stages of their lives: prior to exploitation, during exploitation, and after exploitation. Interviews were transcribed and analyzed using QSR-NVivo, a qualitative coding software, following an inductive coding process to create a coding structure that was categorized around theoretically relevant core phenomena, informed by existing literature on victimization and health access/utilization. Results in this paper focus on interviewee experiences of trauma-informed care. We have categorized that care across trauma informed principles which emerged in positive, neutral and negative ways across various stages of interviewee experiences (before, during, and after exploitation). Participants described more negative experiences with healthcare, reflecting an absence of trauma-informed care, when they were being exploited. The majority of participants’ positive experiences in healthcare settings occurred in the time after they were trafficked. Survivors of sex trafficking as minors describe both their positive and negative experiences with healthcare in ways that align neatly with the Substance Abuse and Mental Health Service Administration’s (SAMHSA’s) six principles of trauma-informed care. The ways that medical providers integrate or contradict SAMHSA’s principles of trauma-informed care impact the experiences of survivors of sex trafficking as minors both during and after their exploitation and impact not only how they feel about their treatment and options, but also their future decisions about engaging with healthcare systems.