Kanani Elaine Titchen

All Publications

• Screening for Unhealthy Relationship Behaviors in Adolescent Patients. Journal of the American Academy of Child and Adolescent Psychiatry Tronick, L., Titchen, K. E. 2026

  View details for DOI 10.1016/j.jaac.2026.03.004

  View details for PubMedID 41850350

• Youth Survivors of Human Trafficking: On Improving Health Care Access and Treatment. Academic pediatrics Titchen, K. E., Chang, E., Kim, J., Tran, S., Nyhan, E., Chisolm-Straker, M. 2025; 25 (4): 102783

  Abstract

  Human trafficking (HT) is a public health issue, with adolescents disproportionately at risk for reasons spanning multiple biopsychosocial domains. We explored youth HT survivors' health care barriers, experiences, and needs.In this qualitative multimethods study, 24 participants (≤26 years old) with HT experience receiving services from nonprofit organizations in San Diego, California completed an electronic survey and were invited to participate in online interviews. Thematic analysis for interview responses was performed using constant comparative methodology. Authors created codes and connections between codes and refined findings by discussion.All participants endorsed labor trafficking, 96% endorsed sex trafficking and 46% reported seeing a health care professional (HCP) while exploited. Nine survey respondents completed follow-up interviews: 100% endorsed labor and sex trafficking and 44% seeing an HCP. Interview participants' barriers to presenting to health care and receiving needed help were categorized into patient-focused-lack of awareness of exploitation and medical needs, emotional bonds to the trafficker, and misperceptions about their ability to obtain care; versus health care system (HCS)-focused-negative experiences and need for consistency with HCPs, and desire for targeted resources and effective care.Barriers to health care for trafficked youth included factors the HCS could change versus those that could be reduced with universal patient education. Participants named lack of legal guardian support and proof of insurance as barriers to health care access while being exploited. Participants noted conventional mental health interventions for recovery are not appropriate and lack survivor-led guidance; participants offered alternatives about how they would receive effective care.

  View details for DOI 10.1016/j.acap.2025.102783

  View details for PubMedID 39827951

• HOOKED: How Human Traffickers Leverage Substance Use for Control. Pediatrics in review Aljadeff, G., Titchen, K. 2024; 45 (6): 366-368

  View details for DOI 10.1542/pir.2023-006197

  View details for PubMedID 38821895

• Medical-Theater Arts Partnerships. Pediatrics Titchen, K. E. 2022; 150 (5)

  View details for DOI 10.1542/peds.2022-057822

  View details for PubMedID 36305210

• Labor trafficking of children and youth in the United States: A scoping review. Child abuse & neglect Greenbaum, J., Sprang, G., Recknor, F., Harper, N. S., Titchen, K. 2022; 131: 105694

  Abstract

  Child labor trafficking is a largely unexplored and unpublished phenomenon in the United States.To 1) characterize the state of the science on child labor trafficking, and 2) identify empirical information regarding risk and protective factors, and physical/behavioral health needs of labor-trafficked children/adolescents.This scoping review involved an electronic review of five databases; the search was restricted to studies in English or Spanish and published between Jan 1, 2010-Oct 16, 2020. The search yielded 1190 articles; 48 studies qualified for full review and 8 met inclusion criteria (US-based study addressing risk factors/vulnerabilities for child labor trafficking; protective factors; health impact; or health/behavioral healthcare).Only one study had sufficient sample size to compare sex to labor trafficking among minors; some did not separate data by age group or by type of trafficking. A few shared data from a common source; one was a single case review. Findings suggested that sex and labor trafficking may share common risk factors (e.g., prior child maltreatment and out-of-home placement) as well as within group differences (e.g., labor trafficked children had less prior child welfare involvement than those involved in sex trafficking and were more likely to be younger, male, Black or non-white, and Hispanic). Multiple physical/behavioral health symptoms were reported and may be useful items for a healthcare screen.Child labor trafficking research in the U.S. is in its infancy, although the results of this review point to opportunities for screening and case conceptualization that may be useful to practitioners.

  View details for DOI 10.1016/j.chiabu.2022.105694

  View details for PubMedID 35749904

• Educating paediatric health-care providers about human trafficking. Journal of paediatrics and child health Coughlin, C. G., Greenbaum, J., Titchen, K. 2020; 56 (9): 1335-1339

  Abstract

  Human trafficking is a public health issue and humanitarian crisis. Most alarming is that children are especially at risk. Although many studies demonstrate that the majority of trafficked persons surveyed engage with the health-care system during the time in which they are trafficked, health-care practitioners lack the knowledge, tools and resources to assist these patients. The present efforts in training health-care professionals have been fragmented and largely ineffective. While prior training has produced short-term changes in knowledge or attitudes of health professionals, it has not produced sustained changes in knowledge and attitudes nor meaningful changes in screening or intervention. No training has demonstrated changes in patient outcomes. Trafficked persons, particularly children and survivors of labour trafficking, are inadequately served by our present training options for health-care practitioners, and evidence-based protocols are needed to care for this underserved, disenfranchised and traumatised population. To provide optimal care for trafficked youth, health-care practitioners may benefit from: (i) evaluating training for health care providers (HCP) rigorously and meaningfully; (ii) advocating for high-quality training for all HCPs; (iii) fostering partnerships with key stakeholders to inform training and practice; and (iv) designing HCP training that is comprehensive, spanning all forms of human trafficking and including all populations involved.

  View details for DOI 10.1111/jpc.15116

  View details for PubMedID 32815607

• Multi-level prevention of human trafficking: The role of health care professionals. Preventive medicine Greenbaum, V. J., Titchen, K., Walker-Descartes, I., Feifer, A., Rood, C. J., Fong, H. F. 2018; 114: 164-167

  Abstract

  As a major public health issue, human trafficking (HT) affects individuals, families, communities, and societies around the world. A public health approach to combating HT has been advocated. Such an approach seeks to prevent HT by engaging diverse stakeholder groups in addressing risk factors at multiple levels. As a key stakeholder group, health care professionals (HCPs) play a critical role in HT prevention. Herein, we use the Centers for Disease Control (CDC) Social-Ecological Model as a framework to present potential HT prevention strategies for health care professionals. As clinicians, HCPs may deliver tailored interventions to patients and families to address individual- and relationship-level risk factors for HT in the health care setting. As educators, advocates, and researchers, HCPs may collaborate across sectors to implement community- and society-level prevention strategies. Such strategies may include enhancing awareness of HT through education; advocating for local and national policies that promote community health and wellness; combating social or cultural norms that contribute to HT; and building a strong evidence-base to guide future HT prevention programs. Guided by the CDC Social-Ecological Model, we recommend that HCPs use their diverse skills to target risk factors for HT at multiple levels and thereby expand their impact in preventing this form of exploitation.

  View details for DOI 10.1016/j.ypmed.2018.07.006

  View details for PubMedID 29981790

• Domestic Sex Trafficking of Minors: Medical Student and Physician Awareness. Journal of pediatric and adolescent gynecology Titchen, K. E., Loo, D., Berdan, E., Rysavy, M. B., Ng, J. J., Sharif, I. 2017; 30 (1): 102-108

  Abstract

  Our aim was to assess: (1) medical trainee and practicing physician awareness about domestic sex trafficking of minors; and (2) whether respondents believe that awareness of trafficking is important to their practice.We designed an anonymous electronic survey, and a convenience sample was collected from June through October 2013.Voluntary participants were 1648 medical students, residents, and practicing physicians throughout the United States.Data were analyzed for correlations between study cohort characteristics and: (1) agreement with the statement: "knowing about sex trafficking in my state is important to my profession"; (2) knowledge of national statistics regarding the sex trafficking of minors; and (3) knowledge of appropriate responses to encountering a trafficked victim.More practicing physicians than residents or medical students: (1) agreed or strongly agreed that knowledge about human trafficking was important to their practice (80.6%, 71.1%, and 69.2%, respectively; P = .0008); (2) correctly estimated the number of US trafficked youth according to the US Department of State data (16.1%, 11.7%, and 7.9%, respectively; P = .0011); and (3) were more likely to report an appropriate response to a trafficked victim (40.4%, 20.4%, and 8.9%, respectively; P = .0001).Although most medical trainees and physicians place importance on knowing about human trafficking, they lack knowledge about the scope of the problem, and most would not know where to turn if they encountered a trafficking victim. There exists a need for standardized trafficking education for physicians, residents, and medical students.

  View details for DOI 10.1016/j.jpag.2015.05.006

  View details for PubMedID 26341745