All Publications

  • Human Trafficking ICD-10 Code Utilization in Pediatric Tertiary Care Centers Within the United States. Frontiers in pediatrics Garg, A., Panda, P., Malay, S., Slain, K. N. 2022; 10: 818043


    Background: Human trafficking is a global public health issue that affects pediatric patients widely. The International Labor Organization estimates children comprise approximately 25% of the identified trafficked persons globally, with domestic estimates including over 2000 children a year. Trafficked children experience a broad range of health consequences leading to interface with healthcare systems during their exploitation. In June 2018, International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) released diagnostic codes for human trafficking.Objective: To use a large, multicenter database of US pediatric hospitalizations to describe the utilization of the ICD-10-CM codes related to child trafficking, as well as the demographic and clinical characteristics of these children.Methods: This study was descriptive in nature. Encounters using data from the Pediatric Health Information System database (PHIS) with ICD-10-CM codes indicating trafficking from June 1, 2018 to March 1st, 2020 were included in the study cohort, with data collection continuing for 30 days after first hospital encounter, until March 31st, 2020. Patients 19 years old and younger were included. Condition-specific prevalence as well as demographic and clinical characteristics for patient encounters were analyzed. Study subjects were followed for 30 days after first hospital encounter to describe healthcare utilization patterns.Results: During the study period, 0.005% (n = 293) of patient encounters in the PHIS database were identified as trafficked children. The children of our cohort were mostly female (90%), non-Hispanic Black (38%), and had public insurance (59%). Nearly two-thirds of patients (n = 190) had a documented mental health disorder at the initial encounter, with 32.1% classified as the principal diagnosis. Our cohort had a 30-day hospital inpatient, overnight observation, or emergency department readmission rate of 16% (n = 48).Discussion: Our study demonstrates a low utilization of human trafficking ICD-10-CM codes in academic children's health centers, with code usage predominantly assigned to Non-Hispanic Black teenage girls. As comparison, in 2019 the National Human Trafficking Hotline identified 2,582 trafficked US children in a single year. These results suggest widespread under-recognition of child trafficking in health care settings, including the intensive care unit, in addition to racial and socioeconomic disparities amongst trafficked children.

    View details for DOI 10.3389/fped.2022.818043

    View details for PubMedID 35252063

  • Barriers to the access and utilization of healthcare for trafficked youth in the United States. Child abuse & neglect Panda, P., Garg, A., Lee, S., Sehgal, A. R. 2021; 121: 105259


    BACKGROUND: Child trafficking is a pervasive public health problem in the United States, with significant health consequences for survivors. Previous studies demonstrated that survivors face barriers to healthcare, though much of the literature has not solely focused on domestic child trafficking.OBJECTIVE: To identify barriers to healthcare faced by survivors of child trafficking in the United States, and to characterize the landscape of available trauma-informed medical services.PARTICIPANTS: 62 adult survivors of child trafficking (83% female, 10% male, 7% transgender; 90% sex trafficking, 25% labor trafficking; median age of entry 16) and 37 community agency professionals who work with trafficked children.SETTING: The United States of America.METHODS: The Barriers to Care Questionnaire (BCQ) was adapted, piloted with a focus group, and disseminated to participants.RESULTS: A statistically significant increase in survivors seeking healthcare after compared to before trafficking was demonstrated (p<0.05). Eighteen consequential barriers to healthcare were identified. The marginalization domain, representing the individual's perception of negative experiences with the healthcare system, had the highest number of consequential barriers. The majority of survivor and agency participants felt the physical and mental health needs of survivors are not being met, but would seek out trauma-informed healthcare if it were available in their community.CONCLUSIONS: Survivors of child trafficking in the U.S. experience a wide range of barriers to healthcare, and a lack of available trauma-informed healthcare. This study identified barriers to healthcare that can be considered by providers hoping to provide accessible and truama-informed services to trafficked children.

    View details for DOI 10.1016/j.chiabu.2021.105259

    View details for PubMedID 34419901

  • Responsibly Including Survivors' Voices in the Planning and Implementing of Educational Programmes for Healthcare Providers ANTI-TRAFFICKING REVIEW Panda, P., Mango, A., Garg, A. 2021: 148-153
  • A Human Trafficking Educational Program and Point-of-Care Reference Tool for Pediatric Residents. MedEdPORTAL : the journal of teaching and learning resources Garg, A., Panda, P., Malay, S., Rose, J. A. 2021; 17: 11179


    Introduction: Trafficked youth experience complex health issues such as substance abuse, severe physical trauma, and sexual health problems, with many entering trafficking between 15 and 17 years old. There is increasing awareness of the need to educate pediatric health care providers on identifying and aiding trafficked children; however, critical gaps in the literature exist regarding educational sessions specific to the human trafficking of pediatric patients. Our objective was to implement and evaluate a survivor-informed educational session for pediatric resident physicians to improve identification of and assistance to trafficked youth in the clinical setting.Methods: We designed an educational session on human trafficking, which included a 60-minute interactive didactic presentation and distribution of a point-of-care reference tool, in collaboration with a survivor of human trafficking, for 59 pediatric trainees in 2019. We utilized pre/post knowledge assessments. Data analysis included descriptive statistics and Fisher exact analysis.Results: Of 99 total eligible residents, 59 (59%) participated. Statistically significant increases in correct identification of hypothetical trafficked youth and next steps for intervention were observed. Over 80% of participants reported comfort with defining, recognizing, referring to, and understanding health consequences of human trafficking on the postassessment, compared to 25% on the preassessment (p < .001).Discussion: Our educational session resulted in statistically significant increased comfort in identification of human trafficking victims and can be replicated at other institutions. The point-of-care reference tool-which can be adapted for use in different settings-can guide pediatric residents in managing suspected trafficked youth in the clinical setting.

    View details for DOI 10.15766/mep_2374-8265.11179

    View details for PubMedID 34568551

  • Barriers to the access and utilization of healthcare for trafficked youth: A systematic review CHILD ABUSE & NEGLECT Garg, A., Panda, P., Neudecker, M., Lee, S. 2020; 100: 104137


    Healthcare has been identified as an important target for training on identification of trafficked youth. Survivors of human trafficking experience challenges in accessing healthcare, both during enslavement and in survivorship.To examine the current evidence in the literature regarding barriers to healthcare faced by trafficked youth.A systematic review of the literature was conducted using the PRISMA guidelines. Through an electronic database search, articles were screened and included if they primarily addressed victims or survivors of child trafficking and focused on barriers to healthcare or problems accessing healthcare. Articles were assessed for overall quality. Data from the articles selected for review were organized into major themes using a framework analysis.Of 3,274 articles resulting from the search, 8 were included in the review. Three sub-themes were coded and classified as extrinsic, intrinsic, and systemic barriers. Extrinsic barriers included trafficker control, physical confinement, and influence of peers. Intrinsic barriers included discrimination, confidentiality, trust in healthcare providers, knowledge of the healthcare system, and emotional reluctance. Systemic issues inherent to the healthcare system included healthcare provider knowledge, complex registration process, language barriers, appointment times, and service coordination.The combination of extrinsic, intrinsic, and systemic barriers leads to reduced utilization and access to medical services for trafficked youth. While extrinsic and intrinsic factors are difficult to eliminate given the clandestine nature of human trafficking, systemic barriers can be eliminated through improving effective training for healthcare providers on identification of victims and implementing trauma sensitive care.

    View details for DOI 10.1016/j.chiabu.2019.104137

    View details for Web of Science ID 000510956200008

    View details for PubMedID 31427098

  • Modern-day Slavery in our Health Care System: An Advocacy Journey PEDIATRICS Panda, P., Garg, A. 2019; 144 (4)


    The following is the winning submission from the third annual Section on Pediatric Trainees essay competition. This year's competition was informed by the 2018-2019 Section on Pediatric Trainees Advocacy Campaign: Advocacy Adventure, which empowered trainees to find their areas of passion, acquire and polish new skills, and organize advocacy efforts collaboratively. We asked writers to share experiences as physician advocates and were impressed with the broad variety of important topics submitted by trainees from around the country. This essay by Drs Panda and Garg highlights a critical issue facing children, human trafficking, and shares their innovative and sustainable survivor-informed training for pediatric trainees. Along with the runner-up submission by Dr Ju, which also appears in this issue, this piece is a wonderfully inspiring reminder that we are all well positioned to advocate for children in our roles as trainees and pediatricians.

    View details for DOI 10.1542/peds.2019-2370

    View details for Web of Science ID 000487649200045

    View details for PubMedID 31501237

  • Public Health Research Priorities to Address US Human Trafficking AMERICAN JOURNAL OF PUBLIC HEALTH Rothman, E. F., Stoklosa, H., Baldwin, S. B., Chisolm-Straker, M., Price, R., Atkinson, H. G., HEAL Trafficking 2017; 107 (7): 1045-1047

    View details for DOI 10.2105/AJPH.2017.303858

    View details for Web of Science ID 000409274400026

    View details for PubMedID 28590857

    View details for PubMedCentralID PMC5463242