Validation of a screening tool for labor and sex trafficking among emergency department patients
Abstract Objective Patients with labor and sex trafficking experiences seek healthcare while and after being trafficked. Their trafficking experiences are often unrecognized by clinicians who lack a validated tool to systematically screen for trafficking. We aimed to derive and validate a brief, com...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-10-01
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| Series: | Journal of the American College of Emergency Physicians Open |
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| Online Access: | https://doi.org/10.1002/emp2.12558 |
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| author | Makini Chisolm‐Straker Elizabeth Singer David Strong George T. Loo Emily F. Rothman Cindy Clesca James d'Etienne Naomi Alanis Lynne D. Richardson |
| author_facet | Makini Chisolm‐Straker Elizabeth Singer David Strong George T. Loo Emily F. Rothman Cindy Clesca James d'Etienne Naomi Alanis Lynne D. Richardson |
| author_sort | Makini Chisolm‐Straker |
| collection | DOAJ |
| description | Abstract Objective Patients with labor and sex trafficking experiences seek healthcare while and after being trafficked. Their trafficking experiences are often unrecognized by clinicians who lack a validated tool to systematically screen for trafficking. We aimed to derive and validate a brief, comprehensive trafficking screening tool for use in healthcare settings. Methods Patients were randomly selected to participate in this prospective study based on time of arrival. Data collectors administered 5 dichotomous index questions and a reference standard trafficking assessment tool that requires 30 to 60 minutes to administer. Data collection was from June 2016 to January 2021. Data from patients in 5 New York City (NYC) emergency departments (EDs) were used for tool psychometric derivation, and data from patients in a Fort Worth ED were used for external validation. Clinically stable ED adults (aged ≥18 years) were eligible to participate. Candidate questions were selected from the Trafficking Victim Identification Tool (TVIT). The study outcome measurement was a determination of a participant having a lifetime experience of labor and/or sex trafficking based on the interpretation of the reference standard interview, the TVIT. Results Overall, 4127 ED patients were enrolled. In the derivation group, the reference standard identified 36 (1.1%) as positive for a labor and/or sex trafficking experience. In the validation group, 12 (1.4%) were positive by the reference standard. Rapid Appraisal for Trafficking (RAFT) is a new 4‐item trafficking screening tool: in the derivation group, RAFT was 89% sensitive (95% confidence interval [CI], 79%–99%) and 74% specific (95% CI, 73%–76%) and in the external validation group, RAFT was 100% sensitive (95% CI, 100%–100%) and 61% specific (95% CI, 56%–65%). Conclusions The rapid, 4‐item RAFT screening tool demonstrated good sensitivity compared with the existing, resource‐intensive reference standard tool. RAFT may enhance the detection of human trafficking in EDs. Additional multicenter studies and research on RAFT's implementation are needed. |
| format | Article |
| id | doaj-art-cd7a474e606442818ecf0f0cbd1c12d3 |
| institution | DOAJ |
| issn | 2688-1152 |
| language | English |
| publishDate | 2021-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj-art-cd7a474e606442818ecf0f0cbd1c12d32025-08-20T03:04:53ZengElsevierJournal of the American College of Emergency Physicians Open2688-11522021-10-0125n/an/a10.1002/emp2.12558Validation of a screening tool for labor and sex trafficking among emergency department patientsMakini Chisolm‐Straker0Elizabeth Singer1David Strong2George T. Loo3Emily F. Rothman4Cindy Clesca5James d'Etienne6Naomi Alanis7Lynne D. Richardson8Department of Emergency Medicine Institute for Health Equity Research Icahn School of Medicine at Mount Sinai Mount Sinai Queens New York New York USADepartment of Emergency Medicine Icahn School of Medicine at Mount Sinai New York New York USAHerbert Wertheim School of Public Health University of California San Diego San Diego California USADepartment of Emergency Medicine Icahn School of Medicine at Mount Sinai New York New York USACommunity Health Sciences School of Public Health Boston University Boston Massachusetts USADepartment of Emergency Medicine Icahn School of Medicine at Mount Sinai New York New York USADepartment of Emergency Medicine, Integrative Emergency Services John Peter Smith Hospital Fort Worth Texas USADepartment of Emergency Medicine, Integrative Emergency Services John Peter Smith Hospital Fort Worth Texas USADepartment of Emergency Medicine Institute for Health Equity Research, Population Health Science & Policy, Icahn School of Medicine at Mount Sinai New York New York USAAbstract Objective Patients with labor and sex trafficking experiences seek healthcare while and after being trafficked. Their trafficking experiences are often unrecognized by clinicians who lack a validated tool to systematically screen for trafficking. We aimed to derive and validate a brief, comprehensive trafficking screening tool for use in healthcare settings. Methods Patients were randomly selected to participate in this prospective study based on time of arrival. Data collectors administered 5 dichotomous index questions and a reference standard trafficking assessment tool that requires 30 to 60 minutes to administer. Data collection was from June 2016 to January 2021. Data from patients in 5 New York City (NYC) emergency departments (EDs) were used for tool psychometric derivation, and data from patients in a Fort Worth ED were used for external validation. Clinically stable ED adults (aged ≥18 years) were eligible to participate. Candidate questions were selected from the Trafficking Victim Identification Tool (TVIT). The study outcome measurement was a determination of a participant having a lifetime experience of labor and/or sex trafficking based on the interpretation of the reference standard interview, the TVIT. Results Overall, 4127 ED patients were enrolled. In the derivation group, the reference standard identified 36 (1.1%) as positive for a labor and/or sex trafficking experience. In the validation group, 12 (1.4%) were positive by the reference standard. Rapid Appraisal for Trafficking (RAFT) is a new 4‐item trafficking screening tool: in the derivation group, RAFT was 89% sensitive (95% confidence interval [CI], 79%–99%) and 74% specific (95% CI, 73%–76%) and in the external validation group, RAFT was 100% sensitive (95% CI, 100%–100%) and 61% specific (95% CI, 56%–65%). Conclusions The rapid, 4‐item RAFT screening tool demonstrated good sensitivity compared with the existing, resource‐intensive reference standard tool. RAFT may enhance the detection of human trafficking in EDs. Additional multicenter studies and research on RAFT's implementation are needed.https://doi.org/10.1002/emp2.12558commercialized violencehuman traffickingidentificationlabor traffickingscreeningsex trafficking |
| spellingShingle | Makini Chisolm‐Straker Elizabeth Singer David Strong George T. Loo Emily F. Rothman Cindy Clesca James d'Etienne Naomi Alanis Lynne D. Richardson Validation of a screening tool for labor and sex trafficking among emergency department patients Journal of the American College of Emergency Physicians Open commercialized violence human trafficking identification labor trafficking screening sex trafficking |
| title | Validation of a screening tool for labor and sex trafficking among emergency department patients |
| title_full | Validation of a screening tool for labor and sex trafficking among emergency department patients |
| title_fullStr | Validation of a screening tool for labor and sex trafficking among emergency department patients |
| title_full_unstemmed | Validation of a screening tool for labor and sex trafficking among emergency department patients |
| title_short | Validation of a screening tool for labor and sex trafficking among emergency department patients |
| title_sort | validation of a screening tool for labor and sex trafficking among emergency department patients |
| topic | commercialized violence human trafficking identification labor trafficking screening sex trafficking |
| url | https://doi.org/10.1002/emp2.12558 |
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