Technical conduct of the child sexual abuse medical examination

Detection of male DNA in the vaginal cavity after digital penetration using Y-chromosome short tandem repeats

In this study, useful genetic information from male donors was obtained on vaginal swabs taken from female volunteers after male digital vaginal penetration in a time frame relevant to a sexual assault investigation. Vaginal swabs were collected from eight volunteers at intervals of 1, 6, 12, 24, and 72 hours after digital vaginal penetration. DNA was extracted from collected swabs and subsequently genotyped using a commercially available Y-chromosome short tandem repeats (Y-STR) multiplex kit. Fifty-eight vaginal swabs were collected and analyzed in the study. Composite Y-STR profiles from all combined volunteers showed that 85% of all possible alleles were detected at the 1-hour interval, 77% of all possible alleles were detected at the 6-hour interval, 73% of all possible alleles were detected at the 12-hour interval, 66% of all possible alleles were detected at the 24-hour time interval, and 71% of all possible alleles were detected at 72 hours after digital vaginal penetration. Results indicate that a viable possibility exists that probative Y-STR profiles, useful for investigative purposes, can be obtained from vaginal swabs taken from subjects exposed to digital penetration at time intervals up to 72 hours postpenetration.

Putting it all together

The most available form of evidence in child sexual abuse cases is what the child has to say about his or her alleged experience. The most difficult skill for clinicians to develop is the "how tos" of talking to children in a developmentally appropriate, nonjudgmental, facilitative, and empathetic manner. This manuscript provides insight into obtaining historical details about a child's experience and guidance regarding how to incorporate those details when formulating a balanced and defensible opinion. The consultative report should be an instrument to explain the presence or absence of physical findings, the significance of symptoms temporally related to sexual contact, and discrepancies between a child's perception of an experience and physical findings.

Funding of child abuse evaluations: survey of child abuse evaluation programs

This article delineates the current fiscal management and reimbursement for child abuse examinations. These financial issues are high priority for child abuse programs because most programs lack the revenues to meet the demands for service, education, advocacy and research. Programs may share medical protocols and standards but have yet to share management solutions. The authors present the administrative details of 75 child abuse evaluation programs and highlight innovative approaches to increase funding and stabilize the funding for the programs. They present information on billing, contracts, costs of care, and state-based initiatives that can be reproduced by other programs and states.

Current issues in the use of colposcopy for examination of sexual assault victims

Colposcopic examination is considered the gold standard in child sexual abuse evaluations in Australia. However, there remain contentious issues with its use, especially in adult victims, which we sought to address by a review of the literature. Colposcopy has been shown to be a sensitive and acceptable tool for detection of anogenital abnormalities in children. The significance of some genital findings remains controversial, especially when images are interpreted by inexperienced clinicians. Its use in adult assessments is hampered by a lack of comparative studies on colposcopically detected genital injuries in adults following consensual v. non-consensual sexual intercourse. Further research is urgently needed before the use of colposcopy can be routinely recommended for adult victims.

Criminal investigations of child abuse: the research behind "best practices"

This article reviews the research relevant to seven practices considered by many to be among the most progressive approaches to criminal child abuse investigations: multidisciplinary team investigations, trained child forensic interviewers, videotaped interviews, specialized forensic medical examiners, victim advocacy programs, improved access to mental health treatment for victims, and Children's Advocacy Centers (CACs). The review finds that despite the popularity of these practices, little outcome research is currently available documenting their success. However, preliminary research supports many of these practices or has influenced their development. Knowledge of this research can assist investigators and policy makers who want to improve the response to victims, understand the effectiveness of particular programs, or identify where assumptions about effectiveness are not empirically supported.

Evaluating child sexual abuse

We have learned much about the medical evaluation of suspected child sexual abuse during the past 2 decades. The physical examination still holds an important place in the evaluation but is secondary to a well-performed history. As the evolving literature increases our understanding, the relevance of various anatomic appearances of the prepubertal and pubertal genital examination will certainly become even clearer. The physical examination rarely is diagnostic by itself, with more than 92% of cases failing to demonstrate either acute or chronic signs of injury. Thus, the 1994 quote by Adams and colleagues, "It's normal to be normal," continues to ring true, now supported by a growing body of pediatric literature.

A USA national survey of program services provided by child advocacy centers

OBJECTIVE

Child Advocacy Centers (CACs) are designed to improve the community collaborative response to child sexual abuse and the criminal justice processing of child sexual abuse cases. CACs, in existence for 16 years, now have standards for membership developed by the National Children's Alliance (NCA) that include nine core components. And yet no systematic examination of the CAC model exists. The purpose of this paper was to assess the variations within these core components as they exist in the field.

METHOD

Using a stratified random sampling design, 117 CAC directors were interviewed using a semi-structured interview that was based on the NCA's standards for membership. The eight core components of the CAC model examined in this study include: a child-friendly facility, a multidisciplinary team, an investigative child interview, a medical examination of the child, provision of mental health services, victim advocacy, case review, and case tracking.

RESULTS

Results reveal the CAC model has been widely adopted by both member and nonmember centers, although variations in implementation exist.

CONCLUSIONS

Future developments in the CAC model must include evaluation of the model.