Implementation of a screening tool for child sex trafficking among youth presenting to the emergency department – A quality improvement initiative

Abstract

BackgroundIdentification of sex-trafficked youth in the emergency department (ED) is difficult and routine screening is uncommon. ObjectivesOur Quality Improvement (QI) Project aimed to increase ED screening and identification of high-risk youth using the Short Screen for Child Sex Trafficking (SSCST). ParticipantsYouth (11 through 17 years) seeking care at two metropolitan EDs with a high-risk chief complaint triggering a best practice alert (BPA). MethodsA BPA prompted administration of the SSCST and referral of screen ‘positive’ youth for comprehensive evaluation for child sex trafficking by the forensic nurse examiner (FNE). Targeted QI interventions defined three study periods (SP). Outcomes measures included screening 50% of high-risk youth with 50% of those youth referred for FNE evaluation. ResultsOver three study periods, 5454/13,956 (39.1%) youth triggered a BPA for high-risk chief complaint; 4354 (78.6%) received the SSCST screen; 1336 (76.0%) of screen-positive youth were referred for FNE evaluation. Outcomes measures were exceeded during all three study periods. SSCST modifications to increase specificity led to a significant decrease in the percentage of positive screens (42.8% SP1 vs 29.4% SP3). Financial programmatic support and further staff training led to an increase in FNE evaluations (86.4 SP3 vs 5.7% of referred youth SP1). Identification of trafficked patients increased from 1.3% of screen-positive youth to 11.3% (SP1 vs SP3; p < 0.0001). ConclusionsRoutine screening for child sex trafficking can be implemented in the ED setting and increases the identification of at-risk youth.