Trafficking, exploitation and forced marriage — formative SAQs

SAQ 1 — Recognising commercial sexual exploitation and the stepwise response (10 marks)

A 15-year-old girl presents to the emergency department at midnight with vaginal discharge. She is accompanied by an older man who answers every question for her and refuses to leave the cubicle. She is withdrawn, avoids eye contact, and cannot tell you the name of her school. The man holds her identification documents. ^{[5] [2]}

Questions

1. What are the relational and clinical red flags in this presentation, and why does this meet a safeguarding threshold? (3 marks) ^[5]
2. Outline your immediate bedside assessment and how you would secure the history. (4 marks) ^{[2] [10]}
3. Describe the definitive stepwise response, including reporting and referral. (3 marks) ^{[2] [15]}

Model answer

Red flags and threshold (3). The relational red flags are a controlling accompanying adult who speaks for her, refuses to leave, and holds her identity documents; the clinical and historical red flags are her withdrawal, avoidance of eye contact, and inability to name her school, alongside a sexually transmitted presentation. Any child or adolescent in commercial sex is a victim of trafficking regardless of force, fraud, coercion or stated consent, and even without an explicit disclosure this constellation meets a reasonable-belief threshold of harm or risk of harm. The clinician reports on reasonable belief, not proof. ^{[5] [2]}

Immediate assessment (4). Address the young person directly, explain confidentiality and its limits, and secure time alone by separating the accompanying adult with a clear, neutral reason — for example that examination policy requires the patient to be seen privately. Use a trained professional interpreter, never the accompanying adult or family, and document who was present. Take a trauma-informed history with open questions about safety, school, who controls her money and documents, and whether anyone has hurt her or made her do something she did not want; believe what you hear, do not press for timeline detail, and do not promise secrecy you cannot keep. Examine for harms with a body map and photographs, arrange STI and pregnancy testing, and refer to the specialist sexual-health and forensic service for genital examination rather than improvising in the cubicle. ^{[2] [10]}

Definitive response (3). Follow the sequence of recognise, separate, safety, assessment, report, refer, and ongoing care. Make the mandatory child-protection report promptly on a reasonable-belief threshold — the statutory duty overrides ordinary confidentiality — and refer in parallel into the National Referral Mechanism or local equivalent, the statutory route to support and formal victim identification. Do not confront or accuse the controlling adult in front of the child; use a calm, neutral hold while the plan is made, and arrange continuity of care so the young person is not lost to follow-up after the first encounter. ^{[2] [15]}