Health care workers in emergency departments should discuss child-trafficking concerns with their patients, emphasizing privacy and confidentiality, according to a new report.

Fear is often the biggest barrier for patients who want to talk, and health care workers can help by increasing agency and providing choices for disclosure, a group of emergency-medicine specialists and pediatricians write in Pediatrics.

“We see patients in the pediatric ED on a daily basis that are at high risk of being trafficked, but it often is not readily apparent,” said lead author Dr. Carmelle Wallace of the University of Alabama at Birmingham.

The majority of trafficking survivors access health care, she said, most likely at emergency departments. Even if patients don’t want to disclose their personal situation, health care workers can discuss trafficking overall and offer resources.

“We have the opportunity to approach potential trafficking survivors in a sensitive and supportive manner that may lead to improved access to vital resources for survival,” she told Reuters Health by email. “For some, we may be their only opportunity to tell someone or access safety.”

Dr. Wallace and colleagues interviewed 17 survivors of child trafficking to create a survivor-derived framework for pediatric emergency departments to talk with their patients. During the interviews, researchers showed a video that depicted a routine emergency-department visit and asked how and when staff might have the best conversations.

All of the participants – 88 percent female – said they want health care workers to ask about trafficking and don’t think it’s harmful or retraumatizing. However, fear was the major barrier, including social and legal implications. They worried that health care workers might judge them, that they wouldn’t be believed or that their situation could get worse.

Health care workers could address fear by emphasizing confidentiality, privacy and agency and approaching patients in a direct, sensitive and nonjudgmental way, according to the interviewees.

“They should say, ‘This is a safe space,'” one participant said. “That’s the word I’d been looking for the whole time I was at the emergency room for six hours or so. I didn’t know if I was safe.”

In addition, specific changes to the emergency-department setup could help with these conversations, they said, including a choice of room, seating and lighting to feel comfortable.

Several participants said they arrived at the emergency department with their trafficker and never had alone time with a doctor or nurse to express their concerns. They desired a genuine, personal connection with a health care worker and preferred to talk to their doctor or nurse rather than being transferred to a social worker.

The participants also provided a list of open-ended questions with specific wording to spark conversations. The questions center around expressing genuine concern for the patient’s emotional and mental state, reassuring the patient, asking for permission to hear more and reiterating that confidentiality is a priority.

“We need to listen to the advice of those who have experienced child trafficking and do what we can to incorporate their suggestions for screening and response,” said Dr. Virginia Jordan Greenbaum of the Children’s Hospital of Atlanta. Dr. Greenbaum, who wasn’t involved in the new study, researches child trafficking at the Stephanie V. Blank Center for Safe and Healthy Children.

“We need to listen more than we talk. We need to see the child beyond the chief complaint that initiated their health visit,” she told Reuters Health by email. “We need to ask questions, be direct, and empower our patients to choose what they want to tell us.”

Although awareness is growing in emergency departments, health care workers still lack training around human trafficking response, which may require funding and institutional support, said Steven Donahue, an emergency nurse at Paoli Hospital in Pennsylvania. Donahue, who wasn’t involved in the study either, trains health care workers on recognizing and helping patients who may be trafficked.

“If you are heartbroken by the exploitation of others and inspired to help, you can make a difference at your health care facility,” he told Reuters Health by email. “Don’t be afraid to ask for assistance in implementing something at your health care facility. We are all here to help and work towards a common goal of healing those in need.”