Medical Standard MDT Training May 24, 2017 National Children’s Alliance Medical Standard MDT Training May 24, 2017

Foothills Child Advocacy Center: Children Served

Children Receiving Medical Services “services” may not mean forensic exam The good news is that the numbers are increasing, but we still have a long way to go– we’re at 8% for total, last year we were at 6% Average for independent 501(C)3 – 33% -- this year that would be 100 children– we have 169 alleged sexual abuse cases

Medical Standard 2011 Specialized medical evaluation and treatment services are routinely made available to all CAC clients and coordinated with the Multidisciplinary Team response. 2017 Specialized medical evaluation and treatment services are available to all CAC clients and are coordinated as part of the Multidisciplinary Team response.

2017: Tougher Guidelines for Medical Professionals Increased continuing education requirement to 8 hours every 2 years (was 3 hours). 50% of all findings deemed abnormal or “diagnostic” of trauma from sexual abuse must have undergone expert review by an “advanced medical consultant” (was only “encouraged” before). Stricter requirements for the “advanced medical consultant” who provides this expert review.

2017: Rationale All children who are suspected victims of child sexual abuse are entitled to a medical evaluation by a provider with specialized training. However, the referral of children for medical examinations should NOT be limited to those for which forensically significant information is anticipated.

2017: Rationale Medical evaluations should be prioritized as emergent, urgent, and non-urgent based on specific screening criteria. Information gathering must be coordinated with the MDT to avoid duplication. Right now, our medical protocols have only emergency and non-emergency categories.

2017: Purpose of a Medical Evaluation “The purpose of a medical evaluation in suspected child abuse extends far beyond providing an evidentiary examination for the purpose of the investigation.”

Goals of Medical Evaluation Help ensure the health, safety, and well-being of the child; Evaluate, document, diagnose, and address medical conditions resulting from abuse; Pretty much the same as 2011

Goals of Medical Evaluation Differentiate medical findings that are indicative of abuse from those which may be explained by other medical conditions; Document, diagnose, and address medical conditions unrelated to abuse; Assess the child for any developmental, emotional, or behavioral problems needing further evaluation and treatment and make referrals as necessary; Pretty much the same as 2011

Goals of Medical Evaluation Reassure and educate the child and family; and Refer for therapy to address trauma related to the abuse/assault, if not provided by another member of the MDT/CAC. The last bullet is new for 2017

Education Reduces Anxiety Children and families are anxious usually due to misconceptions about the exam. Designated non-medical MDT members and CAC staff should be trained and be able to competently respond to common questions, concerns, and misconceptions. No change from 2011 on this, except: DESIGNATED MDT/CAC members educate clients. That’s one reason for the training today.

Are Changes Needed to Our Protocols? Yes, to meet the new standard and as the UVA Forensic Team expands its protocols. UVA recently expanded acute protocols for child abuse to include physical and strangulation, and also added elder abuse and domestic violence.

Recommended Changes Reflected in the Referral Tool Forensic medical evidence will be collected when an acute sexual assault occurred within 120 hours. In NON-EMERGENCY cases, the Foothills staff will work with the investigators, Dr. Parrish, and the family to schedule the appointment as soon after the forensic interview as possible.