Suspected Sexual Abuse Pathway Background and Objective(s): According to the U.S. Department of Health and Human Services, in 2017, there were 674,000 substantiated cases of child maltreatment in the U.S., 8.6% of which were sexual abuse. In Connecticut, there were 8,442 victims of child maltreatment, and 401 of those cases involved sexual abuse/assault. Because management can be complex, this pathway was developed to standardize decision making and assure that medical, forensic, and safety concerns are simultaneously addressed when a child presents with a concern of sexual abuse or assault. The specific objectives of this pathway are to: Create standardization of clinical care for suspected sex abuse/assault Help providers to think about the medical, forensic, safety, and mental health components required when caring for a child of suspected sex assault or abuse Serve as a guide for outpatient medical providers who are determining if a child needs to be sent to the CT Children’s emergency department or not, thereby decreasing unnecessary ED visits or transfers from outside hospitals Direct appropriate history gathering from the child and family Properly identify who should have forensic evidence collection kits performed and how to execute evidence collection appropriately Ensure proper STI testing and treatment is provided in the correct circumstances, based on CDC guidelines Ensure appropriate Department of Children and Families (DCF) reporting Link the child to appropriate medical follow up Algorithm: Download Suspected Sexual Abuse Pathway Algorithm Updated October 11, 2021 Quality Metrics: Percentage of patients eligible for pathway with order set usage Percentage of patients who have a referral to the Suspected Child Abuse and Neglect (SCAN) team Percentage of patients age ≥ 12 years old with pregnancy testing performed Percentage of patients with DCF report completed Percentage of patients with completed and/or offered appropriate STI testing (HIV, syphilis, chlamydia, gonorrhea) Number of patients with forensic evidence collection completed Percentage of patients with forensic evidence collection completed who have a referral to the SCAN team Educational Module: Download Suspected Sexual Abuse Education Module Updated October 11, 2021 Key References: Adams JA et al. Interpretation of medical findings in suspected child sexual abuse: an update for 2018. J Pediatr Adolesc Gynecol. 2018 Jun;31(3):225-231. Adams JA, Kellogg ND, et al. Updated Guidelines for the Medical Assessment and Care of Children Who May Have Been Sexually Abused. J Pediatr Adolesc Gynecol. 2016 April;29(2):81-7. Allen B. Children with Sexual Behavior Problems: Clinical Characteristics and Relationship to Child Maltreatment. Child Psychiatry Hum Dev. 2017 Apr;48(2):189-199. Sexual Assault and Abuse and STDs. Centers for Disease Control and Prevention. 2015. Dwyer K. Mandated Reporters of Child Abuse and Neglect. Office of Legislative Research. 2016. Kellogg ND, et al. Genital Anatomy in Pregnant Adolescents: “normal” does not mean “nothing happened”. 2004 Jan;113(1 Pt 1):e67-9. Kellogg ND, Committee on Child Abuse and Neglect, American Academy of Pediatrics. Clinical Report—the evaluation of sexual behaviors in children. 2009 Sep;124(3):992-8. State of Connecticut Technical Guidelines for Health Care Response to Victims of Sexual Assault. 2017. Pathway Contacts: Nina Livingston, MD Suspected Child Abuse and Neglect (SCAN) Team Rebecca Moles, MD Suspected Child Abuse and Neglect (SCAN) Team