Evidence-Informed Recommendations for Child Sex Trafficking Identification and Response in Ontario Pediatric Emergency Departments: A Modified Delphi Method Study

Children who experience sex trafficking often access emergency departments (EDs) while they are being exploited for related health and psychosocial concerns. However, few clinical resources exist to support ED providers in identifying and responding to presentations of child sex trafficking (CST) in Canada, an internationally recognized source, destination, and transit site for trafficking. This study used a modified Delphi method to propose evidence-informed recommendations for CST identification and response in pediatric EDs. Between July 6 and October 18, 2023, N = 58 Ontario health and social service providers completed three iterative surveys on CST identification, intervention, and referral practices. Providers rated statements using a 4-point Likert scale and provided write-in responses to expand on their survey selections. We analyzed closed-ended responses using descriptive and Kappa statistics, and write-in responses using content analysis. Experts endorsed 57 of the 84 components (68%) to inform clinical practice recommendations for CST identification and response in pediatric EDs, which center on three categories: (1) assessing CST vulnerability factors and indicators, (2) intervention practices that center a culturally responsive, trauma- and violence-informed approach, and (3) in-hospital and community referrals to support the short- and long-term service needs of children who experience sex trafficking. Pediatric ED providers are encouraged to adopt a trauma- and violence-informed approach when incorporating CST identification into existing patient-interviewing methods, such as the pediatric HEADS-ED assessment tool. This population may require specialized services, such as through Sexual Assault/Domestic Violence Treatment Centres and anti-human trafficking community services. While these findings can inform the development of inter-institutional care transition protocols, readily achievable response practices in the ED include providing patient education on saf er sexual health and online practices and establishing community linkages to anti-human trafficking services.