title: Educating health care professionals on human trafficking.
abstract: BACKGROUND
  The US Department of State estimates that there are between 4 and 27 million individuals worldwide in some form of modern slavery. Recent studies have demonstrated that 28% to 50% of trafficking victims in the United States encountered health care professionals while in captivity, but were not identified and recognized. This study aimed to determine whether an educational presentation increased emergency department (ED) providers' recognition of human trafficking (HT) victims and knowledge of resources to manage cases of HT.
  
  
  METHODS
  The 20 largest San Francisco Bay Area EDs were randomized into intervention (10 EDs) or delayed intervention comparison groups (10 EDs) to receive a standardized educational presentation containing the following: background about HT, relevance of HT to health care, clinical signs in potential victims, and referral options for potential victims. Participants in the delayed intervention group completed a pretest in the period the immediate intervention group received the educational presentation, and all participants were assessed immediately before (pretest) and after (posttest) the intervention. The intervention effect was tested by comparing the pre-post change in the intervention group to the change in 2 pretests in the delayed intervention group adjusted for the effect of clustering within EDs. The 4 primary outcomes were importance of knowledge of HT to the participant's profession (5-point Likert scale), self-rated knowledge of HT (5-point Likert scale), knowledge of who to call for potential HT victims (yes/no), and suspecting that a patient was a victim of HT (yes/no).
  
  
  RESULTS
  There were 258 study participants from 14 EDs; 141 from 8 EDs in the intervention group and 117 from 7 EDs in the delayed intervention comparison group, of which 20 served as the delayed intervention comparison group. Participants in the intervention group reported greater increases in their level of knowledge about HT versus those in the delayed intervention comparison group (1.42 vs -0.15; adjusted difference = 1.57 [95% confidence interval, 1.02-2.12]; P < 0.001). Pretest ratings of the importance of knowledge about HT to the participant's profession were high in both groups and there was no intervention effect (0.31 vs 0.55; -0.24 [-0.90-0.42], P = 0.49). Knowing who to call for potential HT victims increased from 7.2% to 59% in the intervention group and was unchanged (15%) in the delayed intervention comparison group (61.4% [28.5%-94.4%]; P < 0.01). The proportion of participants who suspected their patient was a victim of HT increased from 17% to 38% in the intervention group and remained unchanged (10%) in the delayed intervention comparison group (20.9 [8.6%-33.1%]; P < 0.01).
  
  
  CONCLUSIONS
  A brief educational intervention increased ED provider knowledge and self-reported recognition of HT victims.
authors.affiliation: From the *Department of General and Community Pediatrics, Children's National Health System, Washington, DC; †Department of Emergency Medicine, Stanford University School of Medicine, Stanford; ‡Department of Pediatrics, Northern Inyo Hospital, Bishop; §Stanford University School of Medicine, Stanford, CA; ∥Weill Cornell Medical College, New York, NY; ¶Department of Pediatrics, Stanford University School of Medicine, Stanford; #Department of Child Development, California State University, Sacramento; **San Jose Police Department, San Jose, CA; ††Statistical Research Consultants, LLC, Schaumburg, IL; and ‡‡Department of Child and Adolescent Psychiatry, New York University Langone Medical Center, New York, NY.
authors.forename: Aimee M
authors.initials: AM
authors.lastname: Grace
authors.forename: Suzanne
authors.initials: S
authors.lastname: Lippert
authors.forename: Kristin
authors.initials: K
authors.lastname: Collins
authors.forename: Noelle
authors.initials: N
authors.lastname: Pineda
authors.forename: Alisha
authors.initials: A
authors.lastname: Tolani
authors.forename: Rebecca
authors.initials: R
authors.lastname: Walker
authors.forename: Monica
authors.initials: M
authors.lastname: Jeong
authors.forename: Milana Boukhman
authors.initials: MB
authors.lastname: Trounce
authors.forename: Caroline
authors.initials: C
authors.lastname: Graham-Lamberts
authors.forename: Melina
authors.initials: M
authors.lastname: Bersamin
authors.forename: Jeremy
authors.initials: J
authors.lastname: Martinez
authors.forename: Jennifer
authors.initials: J
authors.lastname: Dotzler
authors.forename: John
authors.initials: J
authors.lastname: Vanek
authors.forename: Amy
authors.initials: A
authors.lastname: Storfer-Isser
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Chamberlain
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Horwitz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004502:Education, Medical, Continuing; D060731:Emergency Responders / Q000193:education*; D004636:Emergency Service, Hospital; D005260:Female; D006282:Health Personnel / Q000193:education*; D064410:Human Trafficking / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged