by Jordan Greenbaum, MD

Virginia.Greenbaum@choa.org

The number of cases of suspected sex trafficking seen in Children’s emergency departments (ED) is steadily rising.  This is largely due to improved recognition by law enforcement and the implementation of a community protocol that directs authorities to bring newly identified victims to a Children’s emergency department for immediate medical evaluation.  Between 2014 and 2015, 92 medical exams were completed in the 3 EDs.  In response to the increased awareness of this vulnerable group of youth, Children’s has implemented guidelines for recognizing and responding to suspected cases of child sex trafficking and exploitation.  The guidelines are the product of a multidisciplinary collaboration between providers at the Stephanie Blank Center for Safe and Healthy Children (SVB), and staff from a variety of Children’s departments, including the multiple EDs. Along with a comprehensive overview of sex trafficking, including definitions, potential indicators and detailed instructions on making reports to authorities, the guidelines provide flow diagrams for recognizing and responding to suspected cases.

In the Emergency Departments, providers are asked to consider the possibility of sex trafficking if a child > 11 years old presents with chief complaints of:

• Vaginal or penile discharge
• Requests for STI or pregnancy testing
• Intoxication or ingestion
• Suicide attempt
• Clearance exam for the Division of Family and Children’s Services (DFCS)
• Acute sexual assault

OR, child has

• History of running away from home
• An injury that is suspicious for being inflicted

If these or other concerns are noted, staff should request a social work consult.  The social worker will use the Short Screen for Child Sex Trafficking (also included in guidelines) to further assess for possible victimization.  If staff continues to have concerns, they should contact the Child Protection team by calling the Transfer Center.  A trained nurse practitioner from the SVB Center is available anytime of day to come to the ED to conduct a medical evaluation.  Social work will contact law enforcement, DFCS and Georgia Cares.  The latter is an organization that serves as the entry point for services for child trafficking victims.  Upon notification, staff from Georgia Cares will begin an evaluation and work with authorities to determine post-discharge housing, and further referrals.

Should a child protection on-call nurse practitioner not be available, the guidelines include detailed discussions related to issues of confidentiality and assent, obtaining a medical history and prepping interpreters.  The medical exam protocol is also included, as are STI prophylaxis and HIV PEP guidelines. In addition, the on-call child protection team physician is available for phone consultation at anytime at 404-785-DOCS.