The Children's Justice Center Multidisciplinary Puzzle: Where Does the Medical Exam Fit?

The gold standard for treatment of children who are victims of sexual assault is to provide all victims access to a forensic medical examination, preferably by medical providers trained in child abuse. Although most Children's Justice Centers (CJC) in the Utah have medical teams, there is not a consistent referral process of victims for a medical examination, and therefore most victims do not receive the recommended treatment. Safe and Healthy Family estimates that in 2014 less than 25% of child abuse victims received a medical examination by trained providers. The objectives of this project were to (a) evaluate the current CJC programs within the state to determine if there is a gap in access to medical evaluation of victims of child abuse, (b) create standardized guidelines for the CJC to utilize when referring a victim of sex abuse for a medical examination, and (c) disseminate information about the new Protocol for Sexual Child Abuse Medical Forensic Pediatric Examinations to CJC multidisciplinary teams. The Department of Justice (DOJ) released a national protocol to address pediatric medical examinations for victims of sexual abuse in April 2016: "Although the protocol's focus is on the exam process, it also speaks to the initial community response to prepubescent child sexual abuse, as it is a gateway for victims to access medical forensic care" (DOJ, 2016, p.7). Per Klenig (2012), the Children's Advocacy Center (CAC)/Children's Justice Center model encourages a commonsense approach to addressing child sexual abuse. The use of CAC has expanded worldwide. Pediatric child abuse experts are trained in the diagnosis and treatment of child abuse. These experts include pediatricians, nurse practitioners, and sexual assault nurse examiners (SANE). Tracey (2017) discusses recent studies that indicates when a child is subject to abuse or other traumatic events brain function is altered and damage. This damage to the brain can produce long term individual and social pathological consequences. This project addressed the knowledge deficit of the CJC multidisciplinary team members regarding the treatment of victims of sexual assault by analyzing data from a survey disseminated to the rural CJC centers. Of the surveys disseminated, 133 were completed. Only 12 of those surveyed had knowledge of the DOJ protocol, and 106 participants stated their CJC team did not have a protocol in place for the referral for pediatric sexual assault victims. The DOJ protocol was presented to rural CJC/CAC teams. Education on the sexual assault protocol was completed during rural CJC/CAC staff meetings and served to improve medical access for and treatment of victims of sexual assault. This project aimed to ensure that the gold standard of care is being implemented. Seven rural Utah CJC centers and two CAC representing Pocatello, Idaho and Southwest Wyoming were educated about the new standard of treatment for pediatric sexual assault victims. The new protocol is anticipated to initiate conversations about what changes could be made in these centers regarding the care and treatment of pediatric victims of sexual assault.