HISTORY: Taking a History from the Parent/Caregiver
The purpose of taking this history includes:
Obtaining a complete pediatric history
Obtaining as complete a picture of the sexual offense as the person can provide
Giving the parent/caregiver an opportunity to express his/her feelings about the abuse
and address concerns
Assessing the level of support the parent/caregiver is able to provide the child/adolescent
Providing education about the abuse investigation and legal process
In order to do this, the parent/caregiver needs to feel free to talk with the medical provider privately.
The Social History
A social history should include the following:
Information about the interview
List of all persons present
Name of the primary interviewer
Date, time, and location/site of interview
Information about the child/adolescent
Name, including nicknames
Home address and telephone number(s)
Date of birth
Sex
Ethnicity
Place of birth/country of origin/date of arrival in USA
Language(s) spoken/comprehended
School attended and grade level
Work site(s) if an adolescent
Information about the parent(s)/caretaker(s)
All names, including maiden, married, alternates
Home address and telephone number(s)
Work address and telephone number
Country of origin
Languages spoken; ability to comprehend; need for an interpreter
Name(s) of child's legal guardian if other than parent(s)
Name(s) of those who are involved in the child's care
Source of referral
Source of information about the offense (informant)
An assessment and documentation of the parent/caregiver's reliability and credibility
A parent/caregiver who knows little of the child's personal information and history or who gives confusing, conflicting, or contradictory information during the interview cannot be considered reliable.
Consider whether language difficulties or handicapping conditions are interfering with the ability to relay reliable information.
Much of the above information may be obtained by a social worker who works with the medical provider. Healthcare social workers are invaluable resources and are usually called to assist as part of most hospital child abuse protocols. Using a team approach in the healthcare setting can greatly assist in the acquisition of needed information and in the further care of the patient and family.
The Medical History
The medical history should contain information about the following:
Chief complaint
Accurately record in the parent/caregiver's own words the reason for the evaluation
Document the cause(s) or concern(s) that precipitated or prompted the necessity for an evaluation of abuse (e.g., obvious injury, disclosure on the part of the child, a witness to the event(s), suspicions based on behavior changes, etc.)
Past medical history
Developmental history
Previous injuries or hospitalizations
Allergies
Other medical problems
Family health history
History of bleeding disorders or bleeding in a family member
Siblings who died of sudden infant death syndrome, or who have a serious illness
History of growth delay in siblings, parents, or relatives
Abuse in other family members
Suggested Questions to Ask Regarding Abuse
Sexual
Does your child have any genital complaints?
Vaginal, rectal, penile pain
Staining of underwear, discharge, foul odor
Are there any new or changed behavioral problems?
Are there recurrent somatic complaints?
Abdominal pain, headaches
Physical
Have you noticed any bruising?
Neglect
What kind of appetite does your child have?
Understanding the Uncooperative, Non-Offending Parent
Situations in which the non-offending parent refuses to cooperate with investigative authorities or is resistant to suggestions and advice pose an uncomfortable challenge. A parent may be uncooperative for many reasons. The most common reason is denial regarding the possibility of abuse by a husband, relative, or friend. The non-offending parent may depend on the perpetrator for financial, emotional, or other significant needs. Sometimes the bond between the child and parent is less strong than that between the parent and perpetrator. Sometimes the abuse is so despicable that the non-offending parent is unable to tolerate the information, such as when a child is murdered by a parent.
Whatever the reason, it is important to recognize that the child's future mental health may depend on a continuing relationship with the non-offending parent. Therapeutic goals should recognize the limitations of the non-offending parent and be structured so that the steps are potentially achievable. Consider offering a follow-up appointment in your office and offering choices for counseling. Refer to a therapist located close to the parent's home or who is easily accessible. Sometimes school programs or other local services can be mobilized to provide interventions until the parent is better able to deal with the situation and to focus on the child's needs.
For more information on responding to parents' reactions, see
TREATMENT AND FOLLOW-UP: Responding to Families
.
