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Child Sexual Abuse Triage : Triage Steps

Step 1. Gather and Document Pertinent Information

Clarify and document all contact information, the abuse concern, the child/adolescent's name and age, and the date and time of the call or intake. 

After ascertaining that the child does not need emergency medical care based on severity of injury and need for treatment and/or resuscitation, further questions should help to determine next steps for a suspected child abuse evaluation. (See Step 3 below and CHILD SEXUAL ABUSE TRIAGE : Appropriate Level of Care - Emergent Evaluation.

Ask the caller or presenting caregivers to answer the questions below to the best of their ability. Minimize further trauma by focusing questions on the information immediately available and most pertinent to the child's safety and medical decisions. When asking questions, be careful not to use the word "alleged" or other legal terminology to refer to the incident. The minimal facts interview format may be helpful in obtaining the essential facts to determine the potential need for immediate medical intervention. For more information see Northeast Regional Children’s Advocacy Center Minimal Facts Guidelines.

Questions

  1. Who are you and what is your relationship to the child/adolescent?
  2. What is your reason for concern regarding abuse?
    • Is this a referral from a child abuse investigative agency or child advocacy center?
    • Have you witnessed the abuse?
    • What happened?
    • Did the child/adolescent disclose abuse? If so, to whom was the disclosure made? What are the exact words the child/adolescent used? Who else may have witnessed the disclosure?
  3. Is the child/adolescent safe from the suspected perpetrator now?
  4. Are you safe? Do you think your present situation is dangerous?
  5. Is there a medical concern such as bruising, bleeding, vaginal discharge, or possible pregnancy?
  6. Where on the child’s body did the abuse take place (in very brief detail)?
  7. When did it happen? Last time it occurred? Frequency? Did the incident occur within 120 hours? This timeframe is the critical window for collection of forensic evidence as recommended by the New York State Department of Health and the NYS Division of Juvenile Justice. See New York State Division of Criminal Justice - Evidence Collection Part A – Sexual Offense Evidence Collection Kit

Step 2.  Determine the Safety and Welfare of the Child/Adolescent Is this child/adolescent safe?

Is this child/adolescent safe?

  • If not, and safety cannot be assured prior to transport to an evaluation, make an immediate report to authorities (police and/or Child Protective Services).
  • Does this child/adolescent require hospitalization to protect him or her from further harm? 


Step 3. Determine Who Should Examine the Child/Adolescent and When

If the child/adolescent has any of the following and has presented to a primary care office setting, a local emergency response team should be notified with appropriate referral to an Emergency Department. Similarly, the primary care office may ascertain critical injury and recommend the caller immediately contact emergency medical services for transport to a medical treatment facility specializing in emergency medicine, preferably a hospital-based pediatric emergency department.

Emergency Referral Checklist

  • Symptoms of head trauma: vomiting, headache, syncope, lethargy, visual disturbance
  • Symptoms of abdominal injury: vomiting, abdominal pain, bruising to the abdomen/flank/back, hematuria
  • Symptoms or history of recent traumatic sexual contact: bleeding from the vagina or rectum, genital pain, or other signs of injury

If the incident is within 120 hours and the child/adolescent is medically stable, refer to the appropriate local resource, an Emergency Department or specialized center, for evaluation and possible forensic evidence collection. 

  • If there is a local child abuse pediatrician (CAP), refer the child/adolescent for a CAP consultation. If that is not an option, refer to a local advanced medical consultant. See description in Table 1 in CHILD SEXUAL ABUSE TRIAGE : Suspected Sexual Abuse Overview - Child Abuse Medical Providers .
  • If these medical professionals are not available, proper photo-documentation and clear medical record documentation of the examination is essential for later peer review of findings.
  • If your facility does not offer the appropriate services for pediatric medical care, determine which local facility offers the best services for this child/adolescent and family. For more information, see CHILD SEXUAL ABUSE TRIAGE : Appropriate Level of Care.

Most exams are not an emergency. If the child/adolescent is safe and the incident occurred more than 120 hours prior, the examination can usually be deferred until the next working day.

Step 4. Determine if You are Mandated to Report this Situation

If you have a reasonable suspicion that sexual abuse was perpetrated by a legally responsible adult or that the abuse occurred because of the neglect of the legally responsible adult, you have a responsibility to report this suspicion. In most cases, the concern should be reported immediately, even if the family is being referred to another facility. For more information on reporting, see the REPORTING : When to Report For additional information see New York State Office of Children and Family Services Mandated Reporter Resource Center Resources.

Child Sexual Abuse Triage