There are various family situations related to the suspicion of abuse. The abuser may be a parent, another family member, a stranger, friend, or acquaintance. In any of these situations, the non-offending caregiver may deny the abuse; feel guilty; be supportive of the child/adolescent; and/or respond with anger, remorse, or depression. In most cases, if the child/adolescent is presenting for medical care, the non-offending caregiver has taken appropriate action.
It is important to focus on the medical concerns and assist the family in navigating the system as the investigation and treatment progress. As with any traumatic situation, families often only hear half of what is said to them. Providing written information regarding sexually transmitted diseases, treatment of injuries, and follow-up will help to ensure ongoing, appropriate medical care.
When advocating for the well-being of the child/adolescent, the following guidelines can enhance communication with the non-offending caregiver:
Rapport is critical. Developing an initial rapport with the child/adolescent as well as the family will be beneficial when further discussions regarding possible abuse are necessary.
Clearly state your role as an advocate for the child/adolescent. Remind parents that knowing you would take good care of their child/adolescent is why they came to you in the first place.
Remain neutral in tone and avoid confrontational and accusatory statements. You are attempting to make a diagnosis not conduct a criminal investigation.
If possible, separate the parents from the child/adolescent before asking questions. Explain to the parents that you have a concern and that your usual course of action is to discuss the issues with the child/adolescent. In some cases, the parents will not allow this to occur. You are not responsible for performing an investigative interview, and therefore, do not need to pursue questioning against a parent's wishes.
Most often there are no objective physical findings. Explain why there can be abuse yet not be physical findings.
When there are objective findings of abuse, parents may deny these findings and respond angrily. Again, make it clear that you are the advocate for their child/adolescent's well-being.
Tell the parents that you need help, as does their child/adolescent, to find out who is hurting the child/adolescent. At this point, you can use this opportunity to explain the need to involve other agencies.
Tell parents when you need to call Child Protective Services and/or the police. Explain your duty but do not hide behind the law. That is, if you feel that abuse has occurred, be sure to indicate to the family that these are your concerns. Remind them that you will be there to help them through the process and that you care about their child/adolescent's safety. Advise them of the roles of these other agencies and help them to communicate with agency professionals by providing phone numbers and assistance.
If you are concerned that the child/adolescent may be at further risk of abuse and that notifying the parents of your concerns would jeopardize the child/adolescent's safety, it is not necessary to notify the parents of your report to law enforcement or Child Protective Services. However, in most cases, the parents should have the opportunity to discuss these concerns with you.
Avoid promising the child/adolescent or family that you will be able to protect them, or "make things better." You cannot predict the outcome of the investigation. In most cases, children/adolescents and families will not feel better once the investigation begins. It is often a long and emotionally charged process. Children may be most afraid and concerned that the perpetrator will go to jail.
