The Role of the Non-Sexual Abuse Specialist
Community Health Care Professional

It cannot be assumed that all Child Sexual Abuse (CSA) cases start with a call to the DFACS office which then instructs the family on how to proceed next. Many concerned family members start the investigative process by taking the child to their community health care provider first, either as a response to the child's medical problem, or their own wish to investigate an allegation.

It is an equally unrealistic expectation that all child & family health care professionals are going to have extensive specialized training in the assessment of possible CSA cases.

Therefore, the current section addresses the question of what a non-sexual abuse health care specialist should do at this very first contact, and conversely, what he/she should not do.

Above All, Do No Harm

Abstract: A community healthcare provider who is untrained as a sexual assault examiner should refer any and all suspected cases of abuse to the nearest center where forensically educated staff can provide exams. In most cases, sexual abuse does not manifest itself with physical evidence. Exams need to maximize any evidence and preserve it in a forensically defensible manner.

As medical professionals who work with children, most nurses' heartfelt desire to help the child and the parent can often overshadow their education and training. When a parent presents to the primary care setting, the health department, or to a nurse neighbor with the startling news that the child has possibly been sexually abused, the response which often rises to the top and frequently overrules the basic knowledge-based response is one generated by emotion. The parent wants you to check the child to see if "anything is wrong" and determine whether they should "bother" with the travel and expense of going to an emergency room or specialist's office for a "more complete" examination.

As the provider for most of this child's wellness checks through the years, it is very difficult to say "I can't do that for you" to that devastated parent. Yet reason needs to rule for the health care provider to be guided by the words that physicians repeat as part of their Hippocratic Oath: "above all, do no harm."