Exploitation, Labor and Sex Trafficking of Children and Adolescents: Health Care Needs of Patients

Jordan Greenbaum, Dana Kaplan, and Janine Young (2023)

Purpose

examines the health care needs of children and adolescents who experience human trafficking and exploitation (T/E), including both sex trafficking and labor trafficking.

central argument

health care providers play an important role in identifying and assisting children experiencing trafficking. However, effective intervention requires a trauma-informed, rights-based, culturally sensitive, and patient-centred approach.

Sex trafficking

child sex trafficking involves a person under 18 exchanging a sexual act for something of perceived value.

Labor trafficking

Involves compelling a minor to perform forced labor. Unlike child sex trafficking, force, fraud, or coercion must be demonstrated under the federal definition discussed in the article.

Commercial sexual exploitation of children (CSEC)

A broader concept that includes sexual crimes committed against minors for financial or other economic reasons. Examples include:

• Sex trafficking.

• Underage marriage.

• Production or viewing of child sexual abuse material.

Human smuggling

• Primarily a crime against a country

• involves crossing an international border illegally

• invovles an agreement that ends after crossing the border

human trafficking

• crime involving exploitation of a person

• doesn’t require crossing a border

• involves ongoing exploitation

individual risk factors for trafficking

history of

• maltreatment

• homelessness

• substance misuse

• mental illness

• juvenile justice involvement

• undocumented immigration status

relationship risk factors for trafficking

• family violence

• family dysfunction

• poverty

• forced migration

• rejection of identity or sexual orientation

community risk factors for trafficking

• high crime rates

• lack of community resources

• tolerance of sexual exploitation

• inadequate law enforcement

societal risk factors for trafficking

• gender-based violence

• homophobia

• transphobia

• systemic racism discrimination

• natural disasters

• political instability

Particularly vulnerable populations

• lgbtq+ oyuth

• indigenous and racialized youth

• immigrant and undocumented youth

• homeless and runaway youth

How traffickers recruit and control young people

• Promises of love, attention, money, assistance, or acceptance.

• Offers of seemingly legitimate employment.

• Recruitment through peers, relatives, and community members.

• Social media and other online platforms.

Traffickers may maintain control through:

• Threats of violence against the child or their family.

• Blackmail, fraud, and deception.

• Providing false information about immigration rights, employment rights, or deportation.

Victims may not recognize themselves as victims.

Some children and adolescents believe their participation is voluntary because they feel indebted to the trafficker, love the person exploiting them, or believe they have no alternative.

• The article also emphasizes that leaving exploitation is rarely straightforward. Individuals may return to exploitative situations multiple times because of emotional attachments, financial dependence, fear, and limited alternatives.

Physical health consequences of T/E

• traumatic injuries and assault

• STIs

• unwanted pregnancies

mental/ emotional health consequences of T/E

• PTSD

• depression

• anxiety

A major challenge is that children and adolescents rarely spontaneously disclose their involvement in trafficking.

There are several reasons for this:

• Fear of retaliation from traffickers.

• Fear of police or child protective services.

• Fear of deportation.

Potential warning signs (red flags)

• controlling adult companion

• substance use

• multiple STIs

• previous pregnancies

• malnutrition

• fearfulness

Trauma-informed, rights-based, and culturally sensitive care

emphasize that health care providers must use a trauma-informed approach when interacting with children and adolescents who may have experienced exploitation.

• The goal is to make patients feel safe, respected, supported, and empowered.

safety and trust

• Build rapport

• provide privacy,

• speak with patients without potentially controlling companions present.

privacy and confidentiality

Explain confidentiality and its limitations, including mandatory reporting requirements.

respect

• Listen without judgment,

• demonstrate empathy,

• acknowledge the patient's experiences.

transparency

Explain the purpose of questions, examinations, testing, and treatment.

empowerment and collaboration

Give patients:

• choices,

• seek permission,

• and involve them in decisions about their care.

Documentation, confidentiality, and reporting

An important issue discussed in the article is the tension between documenting medical information and protecting patient privacy.

Children and adolescents may be reluctant to disclose exploitation because they fear that information in their medical records could be accessed by:

• Parents or guardians.

• Law enforcement.

• Child protective services.

• Immigration authorities.

• Other individuals outside the immediate care team.

Mandatory reporting

health care providers have legal obligations to report suspected child abuse and neglect.

immediate needs

• food and clothing

• safe shelter

• medical care

long-term needs

• stable housing

• education

• employment and job training

Secondary traumatic stress among health care providers

involves experiencing symptoms similar to PTSD as a result of learning about and responding to other people's traumatic experiences.

Overall takeaway

human trafficking is not simply a criminal justice issue; it is also a significant public health and child welfare issue.