PERSPECTIVES Domestic Minor Sex Trafficking: Guidance for Communicating With Patients Amy P. Goldberg, MD, FAAP, a,,b Jessica L. Moore, BA, b Christine E. Barron, MD, FAAP a,,b Domestic minor sex trafficking (DMST) is the “recruitment, harboring, transportation, provision, or obtaining of a person for the purpose of a commercial sex act” within domestic borders in which the person is a US citizen or lawful permanent resident ,18 years of age. 1 Over recent years, the perceived paradigm of youth involved in sex trafficking as mainly international criminals and prostitutes has shifted to domestic victims in need of services; this shift has been the result of increased knowledge and research. Potential indicators linked to DMST involvement are described in existing literature, such as runaway behaviors, substance use and/or abuse, dysfunctional home environments, and histories of child sexual abuse. 1,2 Moreover, victimization is associated with health consequences, such as recurrent sexually transmitted infections (STIs), unwanted pregnancies, and untreated chronic medical conditions. 1,2 In an effort to enhance prevention and identification, researchers have attempted to develop screening tools; however, there are limitations, such as small sample sizes, a lack of generalizability (eg, single geographic area), and no current valid and reliable tools. 3 A separate list of screening questions specifically for DMST may be seen by providers as time consuming, irrelevant, and disruptive in their practices. It is also not clearly defined which patients should be screened given that predictive validity of risk factors in the literature does not exist and true prevalence rates of DMST are unknown. 4 Patients may have unanticipated features of a trafficked minor (eg, living at home and doing well in school) and therefore are not screened. 2 Subpopulations of DMST-involved youth (ie, boys; lesbian, gay, bisexual, transgender, and queer youth; and preadolescents) may also be particularly difficult to identify. 5 Given these significant challenges, when a physician uses a universal adolescent risk screening tool (eg, HEADSS, the home education, employment activities, drugs, sexuality, and suicide screening tool), a conversation about DMST may be considered concurrently. 6 If a preadolescent or adolescent has a positive screen result for high-risk factors (Table 1), the following is a recommended guide for a conversation about DMST in the medical setting. Screening questions should be prefaced by establishing a bridge of understanding between the provider and patient. Researchers in a qualitative study who interviewed 21 sex-trafficking survivors identified that providers should normalize the situation through a nonjudgmental approach to remove stigma and shame from the trafficked person. 7 For example, a useful technique is leading with, “I have patients who are involved in selling or trading sex for things like (blank).” This blank can then be filled in with commodities that the evaluator deems potentially relevant to each youth on the basis of the evaluation. For instance, clinicians may discuss a place to stay if evaluating a patient who has run away or money for a minor who express financial concern. a Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island; and b Hasbro Children’ s Hospital, Providence, Rhode Island www.hospitalpediatrics.org DOI:https://doi.org/10.1542/hpeds.2018-0199 Copyright © 2019 by the American Academy of Pediatrics Address correspondence to Amy P. Goldberg, MD, FAAP, Lawrence A. Aubin Sr. Child Protection Center, Potter Building 005, 593 Eddy St, Providence, RI 02903. E-mail: agoldberg@lifespan.org HOSPITAL PEDIATRICS (ISSN Numbers: Print, 2154-1663; Online, 2154-1671). FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose. FUNDING: Supported by Fleet Scholarship grant 101-6345. POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose. Dr Goldberg and Ms Moore conceptualized the study, drafted the initial manuscript, and critically reviewed and revised the manuscript; Dr Barron drafted the initial manuscript and critically reviewed and revised the manuscript; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. 308 GOLDBERG et al by guest on July 3, 2020 www.aappublications.org/news Downloaded from