Health Professional Exams of Suspected Child Victims

Service Delivery Models

The reality of dealing with sexual abuse cases is that not every abused child is currently taken to a nearby, readily available physician specializing in abuse cases. This has several implications:

• Non-physician specialist models as well as physician specialist models are being explored
• More specialists need to be trained
• Non-specialist health care providers need guidelines of what to do and what not to do when child sexual abuse is suspected
• Guidelines need to be developed and refined
• Court acceptance of new specialists needs to be explored
• The use of technology, especially "telemedicine" is being explored as a future way to extend expertise to locations that historically have not attracted the specialists needed.

Ahrens et.al. (2000) point out that Sexual Assault Nurse Examiner (SANE) programs arose from specialized rape crisis programs designed to deal with adult rape victims. Prior to SANE nurses becoming available, rape victims often had to wait hours in a hospital setting before an available doctor became available. In addition, the Emergency Room environment often left a rape victim feeling pressured and rushed while undergoing invasive procedures because of the nature of the exams required. Not all of an Emergency Room staff would have had training specific to the nature of dealing with rape victims, and the specter of dealing with an adversarial legal system left many physicians with strong ambivalence about dealing with rape victims as patients.

The first SANE program was developed in Memphis, Tennessee to attempt to address some of these systemic dilemmas (Ledray & Arndt, 1994). The programs have now proliferated and many SANE nurses now practice in the state of Georgia. The model has been expanded to include a pediatric track so that SANE nurses can also serve child victims of child sexual abuse.

The model is not without it's critics, however. Although few would argue the wisdom of training health providers on how to conduct a forensically sound physical exam, some physicians have raised questions as to whether the foundation training of some of the nurses before obtaining SANE training is always adequate to address the potential health issues in addition to obtaining "evidence" in an investigative process. Rather than attempting to resolve dilemmas that are still in the process of evolution SANE nurses have been received in court as part of the forensic steps in a child sexual abuse cases. Following is an exploration of the issue of physical exams from the perspective of an expert physician who has great authority both nationally as well as within the state.