Child Sexual Abuse: Are Health Care Providers Looking the Other Way?

Not going to give my opinion this time.....but it is a wonderful article SIRI....thanks for sharing

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Child Sexual Abuse: Are Health Care Providers Looking the Other Way?

Posted 08/30/2005

Shelia Savell
Abstract and Introduction

Abstract

This article provides an abbreviated literature review on the role of health care providers in recognizing and reporting child sexual abuse (CSA). Barriers to reporting CSA, data on health care providers' reporting habits, and screening criteria for CSA are also included. Recommendations to enhance recognition of CSA and increase reporting of suspected cases are presented.

Introduction

Child sexual abuse (CSA) is defined as any sexual activity with a child when consent is not or cannot be given; it includes sexual penetration, sexual touching, exposure, and voyeurism (Berliner, 2000; Finkelhor, 1979). Child sexual abuse is a crime and all states have laws related to CSA that specify the age at which an individual can consent to sexual contact, usually between 14 and 18 years (Myers, 1998). In addition, every state mandates that professionals, including physicians and nurses, report suspected child abuse to child protection agencies. The mandate does not require the ability to prove the suspicion, only that reporting must occur any time there is suspicion of CSA. However, multiple studies have demonstrated that professionals do not always report suspected child abuse (Delaronde, King, Bendel, & Reece, 2000; Horner & McCleery, 2000; Ladson, Johnson & Doty, 1987; Lentsch & Johnson, 2000).

Barriers to reporting CSA include inadequate knowledge and training related to CSA, lack of confidence in the evidence collected, fear of harming the child and/or family, lack of confidence in the ability of the social service agency to deal with the investigation, concerns about interacting with the legal system, loyalty to the family, and the belief that an accusation might lead to undesirable consequences (Delaronde et al., 1999; Leder, Emans, Hafler & Rappaport, 1999; Vulliamy & Sullivan, 2000; Willis & Horner, 1987). In addition, Willis and Horner (1987) in their survey of 101 Family Medicine physician faculty and residents found that many physicians did not believe CSA actually occurred at the rates indicated by the literature.

In 2002, 56% of reports of alleged child abuse and neglect were made by professionals. The remaining 44% were made by parents, relatives, friends, alleged victims, alleged perpetrators, and anonymous callers. The largest percentage (16.1%) of professional reports were made by educational personnel, followed by legal and law enforcement personnel (15.7%), and social services personnel (12.6%). Medical personnel reports accounted for only 7.8% of professional reports (United States Department of Health and Human Services [US DHHS], 2004).

Physicians, nurses, and other health care professionals have an important role to play in identifying and treating CSA (American Academy of Pediatrics [AAP], 1999). They can afford the child a safe and private environment in which to disclose and they have the skills to assess, document, and treat or refer for treatment of CSA (Diaz & Manigat, 1999). Clearly, health care providers must expand their role in identifying and reporting CSA. The American Academy of Pediatrics (1999) and the American Professional Society on Abuse of Children (1998) both recommend that providers observe for signs and symptoms of child sexual abuse during routine encounters. They agree screening for abuse (physical or sexual) should be incorporated in every well-child visit.

I think that, in some cases, the perpetrators have become so clever that it might prove difficult for even the most trained professional to recognize sexual abuse. We have a recent case in our county involving a paramedic supervisor who is being charged with 57 counts of child pornography and 21 counts of felony child sexual assault. No one, including his wife who is a critical care nurse, had any idea that this was going on. Four videotapes were confiscated which showed this paramedic having sex with small children, some of whom appeared to be unconscious. The saddest part is that this perpetrator and his wife did foster care and police suspect that at least 2 of the children in the videos were foster children in that home.

http://www.insidebayarea.com/sanmate...ews/ci_3488934

I used to think I could readily tell when a child showed the s/s of age INappropriate sexuality...then shirts that show their belly or look like an under shirt or a slip and show bra straps-if they even have one on-pants that hang below their hips,show their gluteal crease and underwear became the NORM for teen and pre-teen THEN for school age and younger,they can hear about the man who performed fellatio(?sp) on his wife who was really a man on a TV program thats on before 9 PM..........where is the little head banging emoticon when I need it

here ya go

thanks! Thats just how I feel when I see things like that article.banghead: I don't see my co-workers looking away-mental health facility and we produce VOLUMES of suspected abuse reports. The situations are so frustrating,we report over and over and the perps are so often just like the OP pointed out-so clever and manipulative it's hard to prosecute(?sp). Regardless, we keep reporting & trying to support and protect the vulnerable. One of our therapists often reminds us about the correlation of the quality of a society and how the most vulnerable with in it are treated.: