P3B275: Human Trafficking: Voices from the Field

Background: Given their innate dependence on adults and developmentally appropriate impulsive and approval-seeking behaviors, youth are especially vulnerable to the tactics of human traffickers. Multiple studies demonstrated that trafficked persons routinely present to health care while being trafficked. Barriers to care for trafficked youth include misperceptions about labor and sex trafficking which limit identification of trafficked youth in health care settings.

Methods: This was a mixed-methods study of youth survivors of domestic U.S. human trafficking. Youth < 26 years old were invited to participate in an anonymous online survey sent to nonprofit organizations serving trafficked youth in San Diego, CA. Participants were verified as survivors of trafficking by experts at these organizations and by answering the query, “Are you a survivor of slavery, or were you made to work or made to do sexual acts?” Survey questions - including basic demographics and health care encounters - were developed from previously published studies and were revised via collaboration with survivor-advocates.
Survey respondents were then invited to participate in anonymous, online, follow-up interviews conducted via Zoom videoconferencing. Three independent researchers reviewed the interview transcripts to identify major themes. Analysis continued as an iterative process through discussions and refining of the major themes. Subthemes were established using a method of constant comparison to break down higher-level codes (themes) into smaller categories within the framework. Data was coded in Dedoose software to facilitate the reporting of common themes and supporting quotations for constructing the conceptual framework. Techniques to ensure trustworthiness included use of a coding framework, triangulation of data analysis by multiple coders, theory triangulation and member checking.

Results: Seventeen youth with experience of human trafficking completed the survey, and nine of these youth participated in 40-minute, follow-up interviews. Through ongoing discussion and consensus building, investigators noted that emerging themes mirrored variables in the Health Care Access Barriers Model, which was therefore selected as a conceptual model to explain barriers to healthcare for survivors. Emerging themes (and subthemes) included: barriers to identifying trafficked youth (patient driven, provider driven, and lack of signs/features); cognitive barriers (navigating health care systems, lack of awareness of exploitation or mental health needs or substance use disorder needs); financial barriers (gaps in health insurance, housing needs, and the lure of money); structural barriers (lack of medical home, trafficker control, transportation, and lack of ID); and the need for trauma informed care (continuity of care, disclosure, and resilience).

Conclusion: Teens and young adults with lived experience of labor and sex trafficking can and should provide guidance to health care professionals about barriers trafficked persons encounter when seeking health care and recovery, and strategies for overcoming these barriers.