Sexual Abuse Evaluation

Sexual Abuse Evaluation is a difficult area for most families, attorney, courts and mental health professionals to navigate. The Child Advocate is devoted to children and the parents and professionals and presents this summary of the procedure for having a child evaluated.  One must be cautious of the array of self identified experts who have emerged in this field.

The following recommendations are excepts primarily from the POSITION STATEMENT OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Guidelines for the Clinical Evaluation of Child and Adolescent Sexual Abuse.

The purpose of the clinical evaluation of child sexual abuse is to determine whether:

(1) abuse has occurred
(2) the child needs protection
(3) the child needs treatment for medical or emotional problems

Persons doing evaluations must be professionals with special skills and experience in child and adolescent sexual abuse, and evaluations should be performed under the direction of an experienced child and adolescent psychiatrist or psychologist.

The evaluator and the child’s or adolescent’s therapist should be two different individuals. This clarifies roles and preserves confidentiality in treatment.

If custody is an issue, a guardian ad litem for the child should be appointed to represent the child’s best interests, preventing parents from subjecting the child to multiple evaluations in the hope of finding an expert who will support one or another’s contentions.

These evaluations differ from usual clinical evaluations in that more effort needs to be invested in obtaining corroborating information from other sources. This may include medical or school reports, prior psychiatric evaluations, and talking with significant others.

If in the course of treatment abuse is alledged or disclosed then it must be reported.  Child sexual abuse must be reported in accord with ethical and legal requirements in each state. Clinicians should be aware of these requirements. The parent(s) should be informed as clinically, indicated, and to the extent that the child’s best interests are protected. Once the report is made and the legal or child protective services investigation begins, it often becomes difficult to obtain a history from the accused parent, who may become defensive.

Every child who may have been sexually abused should have a physical examination. The medical exam gathers medicolegal evidence and treats any problems related to the abuse. It can be informative and can reassure the child or adolescent.  When possible, the child should be allowed to choose the sex of the examining physician. It is recommended that a trusted, supportive adult remain with the child during the evaluation.Whenever there is the possibility of obtaining forensic evidence, the exam should take place as soon as possible. If the child has been raped, or there is possibility of acute trauma or infection, or the abuse occurred within 72 hours of the disclosure, the child should be examined as soon as possible in order to obtain forensic evidence.

In some cases the evaluator may not be able to determine whether sexual abuse occurred. There are a number of reasons why this may be the case, including contamination by too many evaluations, particularly biased or leading ones. In addition, the child may be too young to verbalize what occurred, the abuse may have happened too long ago, or the child may have been subjected to the undue influence of competing parents and no longer knows what to believe. In such cases, the clinician [and child protective services and the court] must attempt to offer the child reasonable protection while also preserving parent-child ties.

Resources:

• Child Abuse Reporting
• National ACF Programs and Services for Children & Youth
• American Academy of Child and Adolescent Psychiatry and Policy on Abuse
• National CASA