Child sex trafficking identification and response in Ontario pediatric emergency departments: An intersectional mixed methods study

Abstract

Background: Children in Ontario are disproportionately recruited into sex trafficking when compared to other Canadian provinces, and many of those affected access hospital emergency departments for related concerns. Yet, emergency department healthcare providers continue to self-report limited ability to identify and respond to child sex trafficking. Attending to this gap, this dissertation explores child sex trafficking identification and response practices in Ontario pediatric emergency departments. Methods: Guided by intersectionality, an exploratory sequential mixed methods study was conducted between March to October 2023. Twelve in-depth interviews were conducted with pediatric emergency department healthcare providers to examine child sex trafficking identification and response strategies currently enacted in Ontario. Interviews were analyzed using a reflexive thematic analytic approach. Subsequently, a three-round modified Delphi method was conducted with a professionally diverse sample of experts to inform consensus-based practices related to child sex trafficking identification and response. Descriptive and Kappa statistics were calculated for closed-ended survey responses. Content analysis was used to analyze write-in responses. Results: Across 12 interviews, healthcare providers reported having predominantly identified child sex trafficking among white, feminine presenting youth. Providers used trauma- and violence-informed principles to guide their intervention practices. Findings informed the modified Delphi method survey, which was completed by 58 experts in the field of child sex trafficking. Across phases, participants acknowledged the disproportionate representation of marginalized groups in known cases of child sex trafficking; however, Delphi method experts endorsed child sex trafficking identification practices that assess for children’s social environments and behaviours rather than solely considering their intersecting sociodemographic characteristics. Experts endorsed providing patient education on safer sexual health practices and engagement with online platforms. Across study phases, participants underscored the need for integrated rather than siloed service provision including referral submissions to in-hospital and community services. Conclusion: Findings underscored the complexity of child sex trafficking across numerous axes of inequality including poverty, misogyny, and racism. These inequalities uniquely intersected for children along the lifecourse, necessitating a network of services extending beyond the emergency department. Integrated and collaborative services are therefore needed across hospital and community organizations to effectively fulfill the complex and diverse needs of children exposed to sex trafficking.