Sexual Assault Examinations in a Pediatric Emergency Setting
ACLP Bulletin | Fall 2018 | VOL. 36 NO. 4
Janine Patton, MS, CCLS
Texas Children's Hospital, Houston, TX
Intentional Language Choices
As child life specialists, we know that language choice can be critical to the success or failure of an interaction. SAEs are no different in that utilizing safe and honest language can help develop a trusting relationship in a highly sensitive exam. Based on the age of the patient, different word choices may be appropriate. First, it is important to learn how the patient refers to his or her private area. Using familiar terminology can aid in rapport building as well as returning some control to the patient during the exam. Additionally, identifying the patient’s level of understanding of the purpose of the exam can lead to different word selection. For instance,a toddler likely will not understand “evidence collection,” so comparing oral swabs to teeth-brushing can help normalize that aspect for the patient. It can also be helpful to familiarize the child with terminology that they may overhear from conversations that staff are having with the caregiver,including but not limited to: case number, CPS, evidence,forensics, and investigation.
Utilizing a Separate Area for the Exam
Depending on the layout of the ED, conducting the exam in a space other than the patient’s room may not be feasible.However, this accommodation follows the same mentality of having a “procedure room” on an inpatient unit. Utilizing a separate area to complete the exam can help reinforce that the exam is to help keep the patient safe, and that it is only permissible for an adult to be looking at the child’s private area because it is a medical professional who is helping to reinforce that safety. Furthermore, because of the sensitivity of the exam, utilizing a designated room allows the patient’s room on the unit to continue to remain normalized with play or activities. The equipment needed to complete the exam can remain in the designated room and can reaffirm for the patient that once he or she leaves the room, the exam is actually completed. Should the facility not have an available separate space to conduct the exam, the child life specialist can advocate for the equipment to all enter and exit the room at the same time, along with the necessary staff members, in order to help the child distinguish when the exam is beginning and when it is completed.
Forensic Nursing/Sexual Assault Nurse Examiner
Some institutions utilize trained sexual assault nurse examiners (SANEs), registered nurses who are specifically trained to complete sexual assault/rape kits for pediatric victims in a way that fosters an empathetic and caring environment.While this specific role may not be available at every hospital,incorporating professional development opportunities to provide more education to staff members working with these patients can greatly increase the positive outcomes related to the exam.
Children’s Assessment Centers
Many hospitals have specific departments, centers, or external organizations that work to provide follow-up and additional services to patients and their families who complete an SAE. These centers, which may have different names in different locations, provide follow-up checks for patients who may have experienced injuries related to their assault.They also complete additional interviews and can connect families to resources and services for additional coping support as they move forward. These professionals are well trained in working with sensitive and emotional situations,providing empathy and support to families every day.
Research and Professional Development
There is a variety of research available surrounding pediatric SAEs. Several research studies and presentations can be found on the accompanying Specialized Resource article,which can be accessed and shared for further learning opportunities. In addition, valuable resources for children and their families are detailed in this article.
Ultimately, the services and resources that are appropriate for victims of sexual assault will vary from one patient to the next. Additionally, each hospital may approach the exams in a different logistical manner, including the use of a SANE or a designated SAE room. Nevertheless, it is important to note the crucial role that child life can play in creating a more psychosocially supportive environment for a child and family after such a traumatic event as a sexual assault.
Sexual Assault Specialized Resources
Resources for parents/caregivers, patients, and child life specialists/healthcare providers, please see Sexual Assault Specialized Resources.