Trafficking Case 1

History

You are evaluating a 17 year-old female in your outpatient clinic. She has a history of upper respiratory infection and is accompanied by her boyfriend.

On physical exam you notice this tattoo:

You ask the patient about the tattoo, but she clearly does not want to talk about it. When you ask about her living circumstances, you get vague responses from her boyfriend. She is paying for the exam out of pocket.

Concern

You are concerned about sex trafficking.

The tattoo looks trafficking-specific.
The answers to your questions are vague or the patient doesn’t want to answer your questions (guarded historian).
The patient is accompanied by a boyfriend who is speaking for her.

Accessible Version

*Image shows the back of a young person's neck with a bar code and numbers above it. Very much like a product label.

What is the first thing you would do?

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A. Make a report to the Child Abuse Hotline.

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B. Ask the patient if she would like any additional testing regarding other concerns she might have (e.g., HIV testing, STI testing).

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C. Ask the patient’s boyfriend to leave the room in order to ask her more questions about her situation.

What is the first thing you would do?

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A. Make a report to the Child Abuse Hotline.

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B. Ask the patient if she would like any additional testing regarding other concerns she might have (e.g., HIV testing, STI testing).

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C. Ask the patient’s boyfriend to leave the room in order to ask her more questions about her situation.

The best answer is B

Reporting the case might be a consideration. However, your job is to treat her medically. Given your suspicion, you should:

Ask the patient if she has concerns about her body.
- Offer STI testing, pregnancy testing.
- Offer contraception.
Let the patient know that you will take care of her medically any time.
- Provide her with your information so she can come see you in the future.

Before you ask the patient more questions:

Assess the situation in a way similar to a suspected intimate partner violence (IPV) or domestic violence (DV) case.
Consider who is in the room with the patient.
Consider your safety and the patient’s safety.
If someone else is present
1. Observe the interaction
2. Separate the patient from that person
  - To ask more questions
  - To assess safety

When it is safe to question the patient, ask:

If a friend has ever been asked to have sex in return for something.
If she has ever been asked to have sex in return for something and/or if she has ever been asked to have sex with someone else.

If she answers yes, get an assessment of where she is currently in terms of wanting change or wanting to leave the life.

Provide resources including places she can call if she is in a situation where she needs help.
Let her know that she can always come to you for medical care.
Consider the need to involve authorities if there is imminent risk of danger.

If she answers no, let her know that this is something that you have seen.

Show no judgment about this.
Let her know if something happens to her, she can always come back to you for care.

*www.tattoospedia.com