Validation of a screening tool for labor and sex trafficking among emergency department patients

Makini Chisolm-Straker; Elizabeth Singer; David Strong; George T Loo; Emily F Rothman; Cindy Clesca; James d'Etienne; Naomi Alanis; Lynne D Richardson

doi:10.1002/emp2.12558

Validation of a screening tool for labor and sex trafficking among emergency department patients

J Am Coll Emerg Physicians Open. 2021 Oct 12;2(5):e12558. doi: 10.1002/emp2.12558. eCollection 2021 Oct.

Authors

Makini Chisolm-Straker¹, Elizabeth Singer^{2

3}, David Strong⁴, George T Loo², Emily F Rothman⁵, Cindy Clesca², James d'Etienne⁶, Naomi Alanis⁶, Lynne D Richardson⁷

Affiliations

¹ Department of Emergency Medicine Institute for Health Equity Research Icahn School of Medicine at Mount Sinai Mount Sinai Queens New York New York USA.
² Department of Emergency Medicine Icahn School of Medicine at Mount Sinai New York New York USA.
³ Department of Medical Education Icahn School of Medicine at Mount Sinai New York New York USA.
⁴ Herbert Wertheim School of Public Health University of California San Diego San Diego California USA.
⁵ Community Health Sciences School of Public Health Boston University Boston Massachusetts USA.
⁶ Department of Emergency Medicine, Integrative Emergency Services John Peter Smith Hospital Fort Worth Texas USA.
⁷ Department of Emergency Medicine Institute for Health Equity Research, Population Health Science & Policy, Icahn School of Medicine at Mount Sinai New York New York USA.

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.

Keywords: commercialized violence; human trafficking; identification; labor trafficking; screening; sex trafficking; validation.