O3291: Empowering the Pediatric Provider: A Simulation Curriculum to Combat Child Human Trafficking

Background: “Have you been asked to trade sex for clothes, money, housing, or safety? Are you familiar with the term human trafficking?” Although uncomfortable, pediatric providers should be trained to ask these questions. Human trafficking rates continue to rise, and studies reveal that 68-80% of trafficked victims visit healthcare providers during captivity, yet up to 90% go unrecognized. Simulation can be utilized to train providers adequately. There are only a few published training programs for adult trafficking victims and even fewer specific to pediatric victims, who pose unique challenges in identification and management. This study aims to enhance the identification and management of child trafficking victims while improving trainee comfort with difficult conversations using a simulation curriculum.

Methods: A simulation case was developed for resident and fellow learners. The case uses a teenager accompanied by a presumed caregiver presenting to a pediatric emergency department with abdominal pain. Before the simulation, learners completed a pretest with knowledge and validated Likert survey questions. Some learners received a lecture on the identification and management of trafficking victims, while some did not. Participants then engaged in a small group simulation. Learner actions included recognizing trafficking signs, performing a confidential HEADSS exam by asking the caregiver to step out of the room, asking about trafficking history, and initiating police/security contact once the victim was identified. A discussion and posttest followed, mirroring the pretest. An analysis of knowledge retention and change in confidence and comfort scores was completed.

Results: 76 residents and fellows completed the pretest; 39 completed the simulation and posttest. Participants got fewer knowledge responses correct before the simulation (M=57.0%, SD=24.5%) than after the simulation training (M=69.8%, SD=19.2%), independent samples t(87.84)=-3.30, p<.05. When looking at change in comfort, confidence and likelihood of appropriately managing trafficking victims, participants scored higher mean values across all measures- independent sample tests (Q1 t(139)=-10.24, p< 0.001), (Q2 t(135.3)=-8.239, p< 0.001), (Q3 t(132.8)=-14.85, p< 0.001), (Q4 t(97.9)=-10.03, P< 0.001), (Q5 t(138)=-12.167, p< 0.001), (q6 t(99.8)=-13.85, p< 0.001). These independent sample t-tests assumed equal variances for Q1 and Q5 only, based on non-significance of Levene’s test of equality of variances for these questions. All comparisons for lecture groups were non-significant (ps>.10)

Conclusion: Post-simulation results showed a significant improvement in all measures, with no value added by including a traditional lecture format. Therefore, we can conclude that using simulation could effectively enhance provider knowledge and confidence in managing child trafficking victims. This could address a critical gap in medical education. Limitations of this study include a smaller sample size and differing levels of experience prior to simulation. Next steps include expanding the simulation across provider levels and other members of the multidisciplinary team, such as nursing and social work, who come in contact with this population.