I Know Something Happened: Physician Management of Parental Disclosure of Suspected Child Sexual Abuse

Publication ID Published Version
9326 January 29, 2013 9

Description

This is a case scenario simulating a physician encounter with parent with concerns of the sexual abuse of her child. The case scenario was developed to enhance the competencies around the initial steps in management of child sexual abuse. In these cases, the establishment of rapport despite the emotionally charged nature of the issue is paramount in these initial stages. This resource is most applicable for addressing communication skills for trainees interacting with the caregiver of a possible child victim. In addition, this scenario impresses the need for trainees to acknowledge their role as a mandated reporter for all forms of family violence. Other competencies relevant to this case include being familiar with sexual behaviors that are considered developmentally appropriate behaviors in a prepubertal child while acknowledging the implications when there are variations from the norm.

Prior to this experience, many trainees assume that they know how to manage a case of child abuse. After this training, trainees appeared less confident about the initial stages of managing a case of sexual abuse. On the other hand, they could easily identify the competencies they found the most challenging after the experience. The identification of these management challenges will inform curricular efforts on this topic at individual institutions based on available resources. One such challenge identified from our implementation cohort speaks to the fact that there are different skill sets required for each phase of management, from management of a disclosure to documentation of that disclosure to the medical diagnosis based on physical findings. Being able to identify these different skills has enabled trainees to better phrase their clinical question when consulting a specialist in this field. In addition to identifying the required competencies to appropriately manage these cases, the case highlights the trainee’s role as a mandated reporter for all forms of family violence. After this exercise, many trainees were admittedly ambivalent to this role. As a result, one of the focuses of our curricular efforts after this experiencing is acknowledging this role as our trainees advance in their pediatric careers. Another knowledge gap identified through discussions after the experience was that many of the trainees did not feel competent to discuss normal and abnormal sexual behaviors in children and the implication for these behaviors. This led to a presentation on this topic after the experience.

Citation

Walker-Descartes I, Altshuler L, Kachur E, Smith L. I Know Something Happened: Physician Management of Parental Disclosure of Suspected Child Sexual Abuse. MedEdPORTAL Publications; 2013. Available from: https://www.mededportal.org/adea/publication/9326   http://dx.doi.org/10.15766/mep_2374-8265.9326

Educational Objectives

  1. To build rapport with an anxious caregiver who suspects that her child is being sexually abused.
  2. Based on the rapport established, elicit the pertinent historical features that has led to the suspicions of this caregiver.
  3. To document details of the history including the disclosure from the parent.
  4. To acknowledge their role as a mandated reporter for all forms of family violence.

Keywords

  • Child Abuse, Sex Offenses, Disclosure of Sexual Abuse, Child Maltreatment, Parental Disclosure

Specialties

  • Medical
    • Pediatrics
      • Child Abuse Pediatrics

Competencies

  • Interpersonal & Communication Skills
  • Patient Care
  • Professionalism
  • Systems-based Practice

Professional Interest

  • Curriculum Development/Evaluation
  • Physician-Patient Relationship
  • Professionalism
  • Violence

Instructional Methods

  • Assessment
    • Clinical Practice
    • Clinical Reasoning
    • Communication Skills
    • Emotional State
    • Empathy
    • Knowledge
    • Professionalism
  • Case-based Instruction/Learning

Academic Focus

  • Basic Sciences
    • Psychology/Behavioral Science
    • Sociology
  • Clinical Sciences
    • Clinical Skills/Doctoring

Intended Audience

  • Practicing Health Professional
    • Physician
  • Professional School
    • Medical Student
  • Professional School Post-Graduate Training
    • Fellow
    • Resident

Format

  • Standardized Patient

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ISSN 2374-8265