Youth Survivors of Human Trafficking: On Improving Healthcare Access and Treatment.

Background and objectives: Human trafficking (HT) is a public health issue, with adolescents disproportionately at risk for reasons spanning multiple biopsychosocial domains. We explored youth HT survivors' healthcare barriers, experiences, and needs.

Methods: In this qualitative multi-methods study, 24 participants (≤26 years old) with HT experience receiving services from non-profit 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.

Results: 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 a HCP. Interview participants' barriers to presenting to healthcare 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); vs healthcare system-focused - negative experiences and need for consistency with HCPs, and desire for targeted resources and effective care.

Conclusions: Barriers to healthcare for trafficked youth included factors the healthcare system 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 healthcare 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.