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