A child-centered approach to trauma- and violence-informed interventions with children who have experienced sex trafficking: Qualitative findings from emergency department providers in Ontario, Canada

More than 60 % of people who have experienced sex trafficking access an emergency department (ED) for trafficking-related concerns while they are being exploited. Yet, tailored assessment, intervention, and referral practices in the ED remain underexplored. We conducted virtual, semi-structured interviews with 12 multidisciplinary healthcare providers at four pediatric EDs across Ontario to explore how they respond to presentations of child sex trafficking. Through an intersectional, reflexive thematic analysis, narratives illuminated how childhood is redefined in the context of child sex trafficking, with healthcare providers perceiving children who have experienced sex trafficking (CEST) as more mature and less innocent due to their exploitative experiences. These shifting perceptions highlighted the disparate power dynamics that produce and reproduce these children's exploitative vulnerabilities, both within the child-trafficker and child-provider relationships, prompting providers to tailor interventions that incorporate a child-centered approach to trauma- and violence-informed care. This approach considered both developmental needs and the socio-structural factors that implicitly impact children because of their age. In doing so, providers working in Ontario's pediatric EDs are paving the way for integrating a child-centered trauma- and violence-informed approach as a universal standard of practice.