Presenting Medical Evidence in Child Sexual Abuse Cases: Why it’s normal to be normal and why that still matters

Presenting Medical Evidence in Child Sexual Abuse Cases: Why it's normal to be normal and why that still matters
Duration: 60 Minutes
Module 1Resources
Recorded on: 2019-09-10
Unit 1Slide Deck: Presenting Medical Evidence in Child Sexual Abuse Cases
Unit 2Workbook: Presenting Medical Evidence in Child Sexual Abuse Cases
Unit 3Recording: Presenting Medical Evidence in Child Sexual Abuse Cases

Hearing the details of child sexual abuse incidents and cases is dreadful. Unknown to most of us is that ninety-five percent of all delayed child sexual abuse examinations turn out normal. In a world enamored with TV and movies, jury expectations on how these cases should play out and how the evidence must be presented can make serving justice tricky.

To talk about presenting medical evidence in child sexual abuse cases is Laurie Blevins and Roger Blevins. Laurie practices children’s law for the last twenty-five years. She previously served the Arizona Attorney General’s Office’s family law appellate unit and the National Child Protection Training Center. She’s currently working in private practice. Meanwhile, a familiar Justice Clearinghouse personality, Roger is a pediatric nurse practitioner focusing on child abuse pediatrics. Considered an expert in the field, he has a bachelor’s and master’s degree in Nursing and is certified by the Pediatric Nursing Certification Board.

Specifics covered during this session’s discussion include:

  • How far back child sexual abuse has been happening and the extent of such cases in the present time.
  • The concept of Adverse Childhood Events that highlights the impact of childhood trauma on adult’s experiences and well-being.
  • The importance of conducting a delayed sexual abuse examination.
  • What happens in the procedure from the interview to the examination
    • Obtaining a thorough medical history through the interview.
    • The details that must be asked and included during the interview.
    • The limitations of medical history interview where questions must only address the goal of diagnosis and treatment.
    • The nature of information collated through the examination as inadmissible, constituting hearsay evidence and the limited exceptions to the general rule of inadmissibility.
    • Why the identity of the perpetrator is pertinent to medical treatment and how this is treated during the trial.
    • The examination procedure and what the medical professional will do and must do before, during and after the examination.
    • Guidelines on having a comfort person accompanying the child during the examination.
    • Expectations, limitations, and protocols of the child sexual abuse examination.
  • Why the majority of child sexual abuse exams are delayed, why it will rarely yield DNA, and statistics and studies to better understand these.
  • The reality that the vast majority of delayed sexual abuse exams turn out normal due to the physiological characteristics of the body.
  • How to prepare the jury by educating them on the realities of child sexual abuse by providing real-life examples, analogies, and evidence.
  • The importance of conducting child sex abuse examinations despite it turning out to be usually normal.
  • When to seek opinion from another medical consultant.
  • Establishing the expertise of a medical expert and how the experience can affect a child’s outcomes in their adulthood during a trial.
  • Self-care and preventive maintenance that health care providers must practice when repeatedly exposed to details and stories of abuse.
  • The webinar attendees asked questions pertaining to:
    • Determining a child’s ACES score.
    • Forensic interviews – its characteristics and goals.
    • Multi-disciplinary teams in child abuse cases – its benefits, composition, and goal.
    • The comfort person during the examination.
    • The reason for asking the child what she physically felt.

The use of learned treatises and published studies in trial.


Audience Comments:

  • “Everything was valuable. I was able to take a lot away from this as I work closely with sexual assault victims/survivors (children and adult).” — Alexis
  • “It provided an excellent delineation of the forensic interview and medical exam. The balance between dealing with the victim (i.e validation, support, ACE) and establishing a criminal case. Lastly, recognition of “burn out”. — Tony
  • “This was very enlightening! I learned a lot today, thank you!!!” — Corrine
  • “How sensitive this topic is and a better understanding of how exams are conducted with children.” — Rhoda
  • “Learned a different way to ask a child questions with an easier, more comfortable dialogue and word choice. Excellent presentation by BOTH!!” — Nancy


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