An exploratory investigation of the psychological component of the medical examination for child sexual abuse
Child sexual abuse in the United States is a significant problem receiving increased attention in the past 30 years. During this time, disclosure of child sexual abuse has become more accepted and has thus increased. Part of the child sexual abuse evaluation process is the medical exam, which is an invasive, anxiety-provoking experience for an already traumatized child. Examiner clinical practices vary based upon their experience, training, and resources. The child's psychological impact from the exam has been an area of research, but it is unknown whether examiners adequately address the child's psychological needs during an exam.
Twenty-eight medical examiners affiliated with multidisciplinary teams in the northeast U.S. region were interviewed. This exploratory study investigated examiners' clinical practices. In particular, the interventions they implement in relation to training, experience, and knowledge of the literature on the psychological component of the exam.
Results revealed variability in the total interventions employed as well as examiner experience and training. Examiners reported using 14 to 24 interventions during the exam. Overall the total number of interventions employed did not relate to examiner training or experiences. The only significant finding was that those examiners who completed a fellowship focused on child abuse were significantly less likely to implement interventions. Post hoc analysis revealed many significant relationships between an examiner's rated skills training of psychologically related interventions, thus suggesting there may be overlap in training of psychologically related interventions.
The small sample size and the exploratory nature of the study do not make the results generalizable to all examiners who conduct sexual abuse exams. Although we do not know the effectiveness of psychologically related interventions, more attention must be given to the psychological component of the exam. A structured curriculum for these interventions in specialized training programs is one way to improve health care practices and prevent further psychological trauma to the child.
Child abuse & neglect
0622: Clinical psychology