Sexual assault examinations in children. The role of a statewide network of health care providers

C. Kivlahan, R. Kruse and D. Furnell
Missouri Department of Social Services, Jefferson City.

OBJECTIVE--To describe the formation of a statewide network of health care providers to care for child victims of sexual assault and to describe the patients seen by network providers. DESIGN--Clinical description, patient series. SETTING--Private practices, hospital clinics, and emergency departments. PARTICIPANTS--One thousand five hundred fifty-five child victims of suspected sexual assault. SELECTION--Children were referred to the Sexual Assault Findings Examination Network by the state's child protection agency, law enforcement agency, or the child's parent or guardian. No sampling system was used; the children compose the entire population of network patients. INTERVENTIONS--None. MEASUREMENTS AND RESULTS--Detailed physical examinations were performed on all patients, along with extensive collection of pertinent behavioral and historical information. Substantiation of child abuse-neglect by the state's child protection agency was higher in incidents in which SAFE Network providers evaluated the child as compared with all other providers, even where there was no physical evidence. CONCLUSIONS--The network concept, including mandatory training, standard data form and protocol utilization, uniform reimbursement, and continuing education, provides a more reliable level of care for child victims of sexual assault than is available with a variety of providers working independently.