Assistant Professor at the School of Social Work, Affiliate of the Gender and Women's Studies, University of Wisconsin-Madison, USA.
Counseling Psychology Doctoral Student, University of Wisconsin-Madison, USA.
J Health Serv Res Policy. 2021 Oct;26(4):272-281. doi: 10.1177/1355819621997478. Epub 2021 Mar 29.
The United States' Institute of Medicine recommends that health care providers be aware of sex trafficking (ST) indicators and conduct risk assessments to identify people at risk. However, the challenges among those who conduct such assessments remain largely understudied. The aim of this study was to understand the perceived barriers to ST risk assessment among health care providers in a large health care organization.
This study used a collective case study approach in five sites of a large health care organization that serves high-risk populations in a Midwestern state. Twenty-three in-depth, semi-structured interviews were conducted with health care staff (e.g. medical assistants, nurse practitioners). Two research team members conducted independent deductive coding (e.g. knowledge of ST), and inductive coding to analyse emerging themes (e.g. responses to ST risk or commercial sex disclosures, provider role ambiguity).
Although staff routinely screened by asking 'Have you ever traded sex for money or drugs?', participants primarily described avoiding further discussions of ST with adult patients because they (1) aimed to be non-judgmental, (2) viewed following up as someone else's job, and/or (3) lacked confidence to address ST concerns themselves, particularly when differentiating sex work from ST. Differences all emerged based on clinical context (e.g. urban location).
There may be missed opportunities to assess patients for ST risk and use harm-reduction strategies or safety plan to address patients' needs. Implications for practice, policy, and future research are discussed.
美国医学研究所建议医疗保健提供者了解人口贩卖（ST）指标，并进行风险评估，以识别有风险的人群。然而，进行此类评估的挑战在很大程度上仍未得到充分研究。本研究旨在了解大型医疗机构中医疗保健提供者对 ST 风险评估的感知障碍。
本研究采用集体案例研究方法，在中西部一个为高风险人群服务的大型医疗机构的五个地点进行。对医疗保健人员（例如医疗助理、执业护士）进行了 23 次深入的半结构化访谈。两名研究团队成员独立进行了演绎编码（例如对 ST 的了解），并进行了归纳编码以分析新出现的主题（例如对 ST 风险或商业性性行为披露的反应，提供者角色模糊）。
尽管工作人员通常通过询问“您是否曾经为钱或毒品进行过性交易？”来进行筛查，但参与者主要描述了避免与成年患者进一步讨论 ST，因为他们（1）旨在不评判，（2）认为跟进是别人的工作，和/或（3）缺乏自信自行解决 ST 问题，特别是在区分性工作和 ST 时。所有差异均基于临床背景（例如城市位置）而出现。
可能会错过评估患者 ST 风险并使用减少伤害策略或安全计划来满足患者需求的机会。讨论了对实践、政策和未来研究的影响。
