Minor Sex Trafficking Survivors Describe Trauma-Informed Care in Emergency Medicine

Adults who survived sex trafficking as minors often encountered emergency medicine providers while they were being exploited, yet little evidence has existed about how these survivors actually perceive trauma-informed care in healthcare settings. A new qualitative study published in BMC Emergency Medicine addresses that gap by interviewing 35 adult survivors about their experiences with health and healthcare across three stages of their lives: before exploitation, during exploitation, and after exploitation.

The research team, led by Rebecca Pfeffer with colleagues including Jaclyn Houston-Kolnik, Amy Farrell, Jennifer O’Brien, Amelia Wagner, Shani Bacy, Alisa Lincoln and Carlos Cuevas, conducted semi-structured interviews designed to understand participants’ experiences with health and healthcare through those three life stages. The interviews were transcribed and analyzed using QSR-NVivo, a qualitative coding software, following an inductive coding process. That process created a coding structure categorized around theoretically relevant core phenomena, informed by existing literature on victimization and health access and utilization.

The published results focus on interviewees’ experiences of trauma-informed care. The researchers categorized that care across trauma-informed principles, which emerged in positive, neutral and negative ways across the various stages of interviewees’ experiences. This staging matters because many survivors who experienced sex trafficking as minors had contact with emergency medicine providers during their exploitation, and survivors often arrive in emergency medicine settings with complex trauma histories that can shape their decision-making about how, and whether, to seek support.

The central finding is stark: participants described more negative experiences with healthcare, reflecting an absence of trauma-informed care, when they were being exploited. In contrast, the majority of participants’ positive experiences in healthcare settings occurred in the time after they were trafficked. The study therefore links the quality of survivors’ healthcare encounters to where they stood in relation to their exploitation, rather than treating their medical experiences as uniform over time.

A notable pattern in the data is how closely survivors’ accounts mapped onto an established framework. Survivors of sex trafficking as minors described both their positive and negative experiences with healthcare in ways that, according to the authors, align neatly with the Substance Abuse and Mental Health Services Administration’s six principles of trauma-informed care. Trauma-informed practices, policies and procedures, the paper’s background notes, can help clinicians safely and appropriately respond to the healthcare needs of these patients, but evidence about survivors’ own perceptions had been scarce.

The study’s conclusions extend beyond the encounters themselves. The authors report that the ways medical providers integrate or contradict SAMHSA’s principles of trauma-informed care impact the experiences of survivors both during and after their exploitation. Those experiences affect not only how survivors feel about their treatment and their options, but also their future decisions about engaging with healthcare systems.

As with any qualitative interview study, the findings represent the reported perceptions and experiences of the 35 adults who participated, analyzed inductively rather than through controlled measurement. The authors state the interviews were designed around three life stages and coded with qualitative software into a structure organized around core phenomena from existing victimization and healthcare-access literature. The article was published open access on 14 October 2026 and is currently shared as an accepted, peer-reviewed manuscript that is citable and carries a permanent DOI, with a final Version of Record to follow after further edits.

For emergency medicine providers, the study offers a survivor-centered account of which encounters were remembered as harmful and which were remembered as supportive, organized around a framework many clinicians already recognize. The authors’ stated aim was twofold: to explore how individuals who experienced sex trafficking as minors perceive trauma-informed care in healthcare settings, and to identify patterns in those perceptions before, during and after survivors’ experiences with exploitation. The results suggest that the period during exploitation stands out as when trauma-informed care was most often absent, and that care aligned with SAMHSA’s principles was associated with survivors’ willingness to engage with healthcare systems later in life.

Subject of Research: How adult survivors of minor sex trafficking perceive trauma-informed care in medical settings before, during and after exploitation.

Article Title: Perceptions of trauma-informed care: the experiences of minor sex trafficking survivors in medical settings

Article References: Pfeffer, R., Houston-Kolnik, J., Farrell, A., O-Brien, J., Wagner, A., Bacy, S., Lincoln, A., & Cuevas, C. (2026). Perceptions of trauma-informed care: the experiences of minor sex trafficking survivors in medical settings. BMC Emergency Medicine. https://doi.org/10.1186/s12873-026-01761-y

Image Credits: AI Generated

DOI: 10.1186/s12873-026-01761-y

Keywords: trauma-informed care, sex trafficking, emergency medicine, qualitative interviews, SAMHSA principles, survivors, healthcare access, BMC Emergency Medicine, complex trauma, qualitative coding, Perceptions, trauma-informed