All children who are suspected victims of child sexual abuse are entitled to a medical exam conducted by a specialized medical provider. CACs/MDTs can share with families and partner agencies, the importance of why a medical exam is important:
- To ensure the health and well being of the child
- To reassure the child that everything is okay with their body
- To diagnose and treat medical conditions that may be related to sexual abuse
- To document any possible physical and forensic findings
- To allow for collection of evidence that may be present on the child’s body or clothing within 72 hours
It is also important for CACs/MDTs to share with families and partner agencies that most medical exams (over 90%) have normal findings, but that does not mean sexual abuse did not occur. Medical professionals are able to explain “why normal is normal” in court if needed. The medical exam is not painful and assures children and their caregivers that their body is ok in spite of what has happened to them. Please find some online resources and research for your review.
Confronting Commercial Sexual Exploitation & Sex Trafficking of Minors in the United States: A Guide for the Health Care Sector, 2013 Institute of Medicine and National Research Council of the National Academies
The intended audience for this guide is health care professionals, such as physicians, nurses, advanced practice nurses, physician assistants, mental health professionals, and dentists, who see children and adolescents for prevention and treatment of injury, illness, and disease. At any of these encounters—in settings that include, among others, emergency departments, urgent care, primary care clinics, adolescent medicine clinics, school clinics, shelters, specialty clinics (obstetrics/gynecology, psychiatry), community health centers, health department clinics, free-standing Title X clinics, Planned Parenthood, and dental clinics —these health care professionals can have an opportunity to identify and assist young people who are victims of commercial sexual exploitation and sex trafficking.
Examination Findings in Legally Confirmed Child Sexual Abuse: Its Normal To Be Normal, 1994. Joyce A. Adams, MD; Katherine Harper, PA-C; Sandra Knudson, PNP; and Juliette Revilla, FNP.
Studies of alleged victims of child sexual abuse vary greatly in the reported frequency of physical findings based on differences in definition of abuse and of "findings." This study was designed to determine the frequency of abnormal findings in a population of children with legal confirmation of sexual abuse, using a standardized classification system for colposcopic photographic findings.
Genital Anatomy in Pregnant Adolescents: "Normal" Does Not Mean "Nothing Happened". 2004, Pediatrics, Nancy D. Kellogg, MD; Shirley W. Menard, RN, PhD, CPNP, FAAN; and Annette Santos, RN, SANE.
Many clinicians expect that a history of penile-vaginal penetration will be associated with examination findings of penetrating trauma. A retrospective case review of 36 pregnant adolescent girls who presented for sexual abuse evaluations was performed to determine the presence or absence of genital findings that indicate penetrating trauma. Historical information and photograph documentation were reviewed. Only 2 of the 36 subjects had definitive findings of penetration. This study may be helpful in assisting clinicians and juries to understand that vaginal penetration generally does not result in observable evidence of healed injury to perihymenal tissues.
International Association of Forensic Nurses, Sexual Assault Nurse Examiner (SANE) Education Guidelines, 2015
The primary purpose of the International Association of Forensic Nurses Sexual Assault Nurse Examiner (SANE) Education Guidelines is to help the sexual assault nurse examiner meet the medicolegal needs of those who have been affected by sexual violence, including individual patients, families, communities, and systems. Registered nurses who perform medicolegal-forensic evaluations must receive additional and specific didactic and clinical preparation to care for adult, adolescent, and pediatric patients following sexual violence or assault. The sexual assault nurse examiner practicing within recommendations set forth in the Sexual Assault Nurse Examiner (SANE) Education Guidelines uses the nursing process and applies established evidence-based standards of forensic nursing practice to ensure that all patients reporting sexual violence and victimization receive competent medicolegal-forensic evaluation, taking into consideration developmental, cultural, racial, ethnic, sexual, and socioeconomic diversity.
Interpretation of Medical Findings in Suspected Child Sexual Abuse: An Update for 2018.
Most sexually abused children will not have signs of genital or anal injury, especially when examined nonacutely. A recent study reported that only 2.2% (26 of 1160) of sexually abused girls examined nonacutely had diagnostic physical findings, whereas among those examined acutely, the prevalence of injuries was 21.4% (73 of 340). It is important for health care professionals who examine children who might have been sexually abused to be able to recognize and interpret any physical signs or laboratory results that might be found. In this review we summarize new data and recommendations concerning documentation of medical examinations, testing for sexually transmitted infections, interpretation of lesions caused by human papillomavirus and herpes simplex virus in children, and interpretation of physical examination findings. Updates to a table listing an approach to the interpretation of medical findings is presented, and reasons for changes are discussed.
Medical Linkage Agreement, RCAC, 2016.
National Best Practices for Sexual Assault Kits: A Multidisciplinary Approach
Released by the National Institute of Justice (Office of Justice Programs, U.S. Department of Justice), this resource is a collection of information and best practices for the use of sexual assault kits by multidisciplinary teams.
National Protocol for Sexual Abuse Medical Forensic Examinations
This is a guide for: (1) health care providers who conduct sexual abuse medical forensic examinations of prepubescent children; and (2) other professionals and agencies/facilities involved in an initial community response to child sexual abuse, in coordinating with health care providers to facilitate medical forensic care. The main goals of a pediatric sexual abuse medical forensic examination, as described in this protocol, are to:
- address the health care needs of prepubescent children who disclose sexual abuse or for whom sexual abuse is suspected;
- promote their healing; and
- gather forensic evidence for potential use within the criminal justice and/or child protection systems.
Pediatrician Role in Child Maltreatment Prevention, 2010, American Academy of Pediatrics
It is the pediatrician’s role to promote the child’s well-being and to help parents raise healthy, well-adjusted children. Pediatricians, therefore, can play an important role in the prevention of child maltreatment. Previous clinical reports and policy statements from the American Academy of Pediatrics have focused on improving the identification and management of child maltreatment. This clinical report outlines how the pediatrician can help to strengthen families and promote safe, stable, nurturing relationships with the aim of preventing maltreatment. After describing some of the triggers and factors that place children at risk for maltreatment, the report describes how pediatricians can identify family strengths, recognize risk factors, provide helpful guidance, and refer families to programs and other resources with the goal of strengthening families, preventing child maltreatment, and enhancing child development.
The Evaluation of Sexual Abuse in Children, Nancy Kellogg, MD; and the Committee on Child Abuse and Neglect, American Academy of Pediatrics, 2015
Abstract statement titled “Guidelines for the Evaluation of Sexual Abuse of Children,” which was first published in 1991 and revised in 1999. The medical assessment of suspected sexual abuse is outlined with respect to obtaining a history, physical examination, and appropriate laboratory data. The role of the physician may include determining the need to report sexual abuse; assessment of the physical, emotional, and behavioral consequences of sexual abuse; and coordination with other professionals to provide comprehensive treatment and follow-up of victims.
Updated Guidelines for the Medical Assessment and Care of Children Who May Have Been Sexually Abused, 2016.
The medical evaluation is an important part of the clinical and legal process when child sexual abuse is suspected. Practitioners who examine children need to be up to date on current recommendations regarding when, how, and by whom these evaluations should be conducted, as well as how the medical findings should be interpreted. A previously published article on guidelines for medical care for sexually abused children has been widely used by physicians, nurses, and nurse practitioners to inform practice guidelines in this field. Since 2007, when the article was published, new research has suggested changes in some of the guidelines and in the table that lists medical and laboratory findings in children evaluated for suspected sexual abuse and suggests how these findings should be interpreted with respect to sexual abuse. A group of specialists in child abuse pediatrics met in person and via online communication from 2011 through 2014 to review published research as well as recommendations from the Centers for Disease Control and Prevention and the American Academy of Pediatrics and to reach consensus on if and how the guidelines and approach to interpretation table should be updated. The revisions are based, when possible, on data from well-designed, unbiased studies published in high-ranking, peer-reviewed, scientific journals that were reviewed and vetted by the authors. When such studies were not available, recommendations were based on expert consensus.
RESOURCES FROM THE MIDWEST REGIONAL CAC:
- PROTOCOL and TRAINING GUIDELINES FOR THE MEDICAL STANDARD, 2017
- TO OBSERVE OR NOT TO OBSERVE
- TRAINING AND PEER REVIEW RESOURCES FOR CAC MEDICAL PROVIDERS
- SAMPLE EXPERT REVIEW LOG
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Disclaimer: The resources provided are not an exhaustive list and more may be added in the future. Additionally, many are links to outside websites, which may, from time to time, update their content.
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