Oral Papers: Collaborative Care & Community C-L II
Oral Paper
.jpg "Lujain Alhajji, MD photo")
Lujain Alhajji, MD
Assistant Professor
University of Miami Miller School of Medicine
Miami, Florida
Ashton Sanchez
Social Worker
University of Miami
Miami, FL
Amalia Martinez, MD
Chief Resident
Jackson Memorial Hospital
Miami Springs, FL
Stephen Symes, MD, FACP
Associate Professor
University of Miami Miller School Of Medicine
Miami, Florida
Donald Jeffrey Newport, MD
Professor
University of Texas at Austin, Dell Medical School
Austin, TX
JoNell Efantis Potter, PhD
Professor
University of Miami Miller School of Medicine
Miami, FL
Background:
Human trafficking (HT) uses coercion, threats, and fraud to force individuals to engage in labor or commercial sex acts. Most trafficking victims will contact healthcare services during their exploitation (Chisolm-Straker et al., 2016). Survivors present with psychiatric illness, substance use, pain, sexually transmitted diseases, and unplanned pregnancies (Ottisova et al., 2016; Zimmerman et al., 2014). The University of Miami THRIVE (Trafficking Healthcare Resources and Intra-Disciplinary Victim Services and Education) is a trauma-informed, collaborative care clinic, established in 2015, to provide HT survivors with access to primary care, psychiatry, and obstetrics/gynecology services. Social work support and peer advocacy is provided on site by THRIVE.
Methods:
The characteristics and perinatal outcomes of pregnant HT survivors referred to THRIVE are presented.
Results:
77 patients were referred to THRIVE, six were pregnant. One patient was lost to follow up and excluded. All were sex-trafficking survivors, experienced abuse in adulthood, and four reported childhood abuse. The mean age at first visit was 21.4 years old. All patients had psychiatric co-morbidities, most commonly PTSD, depression and/or substance use. Two patients had prior pregnancy terminations while trafficked. All pregnancies were unplanned. The mean gestational age at referral to THRIVE was 31 weeks gestation, while mean gestational age at delivery was 37 weeks. Two patients had a vaginal birth, while three patients were delivered via C-section. After delivery, three patients were discharged to independent living, one to a shelter, and one to an extended foster care facility. Child protective services were contacted in three cases, with one resulting in separation. Tailored perinatal and psychiatric care was individually provided for all patients.
Conclusion:
Perinatal healthcare services may be the initial point of contact for trafficking survivors. Difficulties in establishing trust due to fear, stigma, legal issues, ongoing violence and sexual exploitation may delay entry into care. THRIVE’s collaborative care model improved access and coordination of services for pregnant HT survivors. Given the magnitude of psychiatric co-morbidities, a collaborative care approach among multi-specialty healthcare providers is vital to facilitate improved perinatal outcomes.
References:
(1) Chisolm-Straker M, Baldwin S, Gaïgbé-Togbé B, Ndukwe N, Johnson PN, Richardson LD. Health care and human trafficking: we are seeing the unseen. Journal of health care for the poor and underserved. 2016;27(3):1220-1233.
(2) Ottisova L, Hemmings S, Howard LM, Zimmerman C, Oram S. Prevalence and risk of violence and the mental, physical and sexual health problems associated with human trafficking: an updated systematic review. Epidemiology and Psychiatric Sciences. CJO 2016.
(3) Zimmerman C, Kiss L. Pocock N, Naisanguansri V, Soksreymom S, Pongrungsee N et al. 2014. Study on Trafficking, Exploitation and Abuse in the Greater Mekong Subregion (STEAM). London School of Hygiene and Tropical Medicine, International Organisation for Migration.