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The role of medical providers in prevention, recognition, treatment, and follow-up of children and adolescents who have been abused varies according to the specialty-specific role of the provider. In general, the medical-legal responsibilities are the same, and the relationships that these providers foster in working with community agencies are similar. A multidisciplinary team approach is recommended because it allows for a coordinated response to child/adolescent victims and creates a system of investigation and prosecution of child abuse that causes the least possible trauma to children/adolescents and families while ensuring their safety and well-being.

Medical providers involved in child abuse cases are often physicians, such as pediatricians, family practitioners, emergency medicine physicians, and obstetrician/ gynecologists. Registered nurses, nurse practitioners, and physician assistants also provide medical care. These professionals work under the supervision of a physician. Hospital-based medical providers may work with a hospital social worker.

line spacer Physicians should know about the special developmental and emotional needs of child and adolescent abuse victims. They should be able to recognize behavioral indicators and clinical signs of abuse, know when it is appropriate to obtain laboratory tests, radiographs, and photographs, how to collect forensic evidence, and how to determine an appropriate treatment plan. Familiarity with local Child Protective Services and other services available to abused children/adolescents and their families is essential. In addition, the physician must understand the roles of other professionals, be willing to provide consultation to them, objectively document findings, and be willing to provide testimony in court proceedings.

Physicians may provide:

  • Support to the child/adolescent and family

  • Prevention information, resources, and strategies to the child/adolescent's caregiver or family

  • Medical evaluation, diagnosis, and treatment

  • Medical documentation of information and evidence gathered during the examination

  • Behavioral and developmental assessments

  • Medical evaluations of other children present in the household that may be subject to abuse

  • Recommendations, when necessary, that the hospital administrator take temporary custodial care of an abused child/adolescent to avoid risk of injury

  • A complete review of medical records

  • An opinion regarding the physical findings and their significance for abuse to a reasonable degree of medical certainty

  • Expert or factual witness testimony in court

  • Assistance in the forensic interview when requested by the investigative team if the physician has the appropriate background and experience

  • Referral, if necessary, for medical follow-up

  • Referral for mental health counseling

  • Referral to a victim advocate

  • Referral to other team member agencies for investigation, when needed

  • Research in the field of child abuse

Primary Care Providers
The role of primary care providers is to recognize risk factors for and indicators of abuse, diagnose and report abuse, offer primary treatment of abuse injuries, and refer for further medical, social, or mental health treatment.

Emergency Medical Care Providers
The role of emergency medical care providers is to treat injury, recognize abuse and risk factors for abuse, establish a relationship with the primary care provider, make referrals, and provide patient follow-up information. In general, the emergency medical care providers do not have the opportunity to provide longitudinal comprehensive pediatric care and are more likely to encounter acute cases of child abuse. For more information on emergency medicine, see .

Child Abuse Pediatricians
The American Board of Pediatrics will soon offer certificates in Child Abuse Pediatrics to qualified pediatricians. Information about the eligibility criteria can be found on the American Board of Pediatrics website and search on child abuse pediatrics.

In New York State, child abuse medical experts are identified through the Child Abuse Medical Provider (CHAMP) Program. The CHAMP Program has developed criteria for expertise in providing medical care to sexually abused children and applies that criteria to physicians, nurse practitioners and physician assistants. These professionals serve as Mentors for the CHAMP training program and their facilities are CHAMP Centers of Excellence. For information about CHAMP training in child sexual abuse evaluation and treatment visit .

Registered Nurses
line line Nurses are mandatory reporters, and therefore, should be aware of the indicators of child abuse.

Forensically Trained Nurses
Forensically trained nurses are registered nurses who have successfully completed a basic Sexual Assault Nurse Examiner (SANE) course or a Sexual Assault Forensic Examiner (SAFE) course. SAFE nurses have been primarily utilized to evaluate adult sexual assault victims. Their expertise in forensic evidence collection and appropriate medical management can be crucial to the prosecution of a case as well as to the well-being of the adult sexual assault victim.

There are significant differences in the forensic examination of a child versus an adult. Because a SAFE course generally does not include pediatrics, additional training is required in pediatric normal anatomy, physiology, developmental milestones, and child protective issues before these registered nurses can work with pediatric patients. SAFE trained nurses also should have a minimum of two years of recent, acute care experience, preferably in pediatrics or emergency nursing, a preceptorship with an experienced CHAMP provider, and/or the experience of observing/assisting a minimum of 40 pediatric sexual abuse exams.

SAFE-assisted exams must be performed in conjunction with a physician or qualified physician extender. Guidelines for the role of SAFEs examining pediatric patients can be found in Chapter 12 of the SANE Development and Operation Guide. For more information, see .

SAFE Nurses may provide:

  • Assistance with the identification of sexual abuse

  • Identification of the need for evidence collection

  • Expertise in child abuse colposcopy and photodocumentation with a camera

  • Documentation of examination findings

  • Assistance with interpretation of examination findings

  • Identification of need for referral to child abuse medical provider and/or a multidisciplinary team through a Child Advocacy Center

  • Assistance with referrals for follow-up medical and mental health care

  • Reporting or assistance with reporting to the State Central Register or law enforcement

  • Assistance with medical care including sexually transmitted disease prophylaxis

  • Education of the child/adolescent and family

  • Testimony in a court of law

  • Research in the field of child abuse

Physician Extenders
line spacer Nurse practitioners and physician assistants function in the role of primary care provider for many children in New York State. Because they may be the only provider that a child sees, they must be able to identify abuse. As mandated reporters they are required to properly report suspicions of abuse. Nurse practitioners and physician assistants function in a variety of settings, such as working with a physician and functioning as part of Child Advocacy Center multidisciplinary team.

Nurse Practitioners
Nurse practitioners (NPs) are certified to practice in a specific specialty area and may be certified in more than one specialty. Current specialty areas are acute care, adult health, college health, community health, family health, gerontology, holistic care, neonatology, obstetrics/gynecology, oncology, pediatrics, palliative care, perinatology, psychiatry, school health, and women's health. Prior to beginning practice, nurse practitioners establish a practice protocol that identifies how they will work in collaboration with the physician. They may provide case management, diagnosis, treatment, and appropriate record keeping, as well as other functions. For more information, see the New York State Education Department Office of the Professions and search on Nurse Practitioner .

Physician Assistants
Physician assistants (PAs) are licensed healthcare professionals who provide medical care under the supervision of a physician, using the scope of practice of the supervising physician. PAs provide a wide range of care and practice medicine under the New York State Physician Education Article 131-B.

Nurse practitioners and physician assistants working in the field of child abuse should have specialized training obtained through formal course work or continuing professional education. Working in collaboration with a physician, nurse practitioners and physician assistants can be involved in all aspects of the care of a child/adolescent being evaluated for suspected child abuse.

Physician extenders may provide:

  • Initial contact with the family
  • Medical evaluation that includes taking the history and performing the physical exam, including colposcopy when indicated
  • Referrals for diagnostic tests
  • Coordination of specialty services
  • Liaison with agencies as a multidisciplinary team member
  • Education to families and the community
  • Testimony in family and criminal court as an expert or fact witness
  • Research in the field of child abuse

Hospital Social Workers
line spacer In a hospital setting there are often many experienced social workers that work collaboratively with medical providers in the reporting and management aspects of suspected child abuse cases. The New York State Department of Health regulations require that hospitals designate a staff member as the Child Protection Coordinator to coordinate compliance with the reporting requirements concerning suspected child abuse and maltreatment. The Child Protection Coordinator is often, but not always, a social worker. For more information, see REPORTING: How to Make a Report in a Hospital Setting.

Social workers may provide:

  • Additional information to make reports complete
  • Assistance with reports so that they are made in a timely fashion
  • Referrals to appropriate services for children, adolescents, and families
  • Short-term crisis and therapeutic intervention
  • Feedback and coordination of evaluations among hospital staff
  • Facilitation of communication with child protective worker and/or the police and the district attorney, as appropriate
  • Testimony in a court of law
  • Research in the field of child abuse

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