Introduction
Children and youth are often easy targets for sexual victimization. Although not
all sexual activities with children are violent, the psychological effects may be quite
traumatic, far reaching, and long-lasting. Public awareness and alertness to sexual abuse
of children is at its highest. In isolated duty stations with children and families
nearby, a GMO may have to field questions pertaining to the possibility of sexual abuse of
a child.
The disclosure or discovery of possible sexual abuse of a child is a very significant
and a powerful event. Strong emotions are quickly aroused in family, friends,
investigators, and those accused (the perpetrators). The medical officer may be the first
professional notified and therefore in a critical position. Providing support,
information, and basic medical care is the primary task of the GMO.
Family Advocacy Representative
The assessment of sexual abuse is a complex process usually involving professionals
from child protective services, police agencies, mental health, and medicine. Coordination
of the assessment is often difficult and confusing. Navy instructions direct family
advocacy representatives (FAR) to take the lead role.
The FAR is always the first person to contact in a sexual abuse case as mandated by
Navy instruction. Most State statutes also require reporting to civilian
authorities (child protective services).
General guidance
Common sense and sensitivity dictate the medical examination in a child sexual
abuse case. Sexual abuse of children does not always involve physical trauma. The history
as obtained from parents, guardians, or authorities should provide some guidance to the
medical officer's decision regarding extent and degree of physical examination. Any and
all acute injuries should be appropriately and carefully treated and documented. Physical
evidence is critically important in sexual abuse cases. A sexual assault kit and other
specimens should be obtained with the assistance of appropriate authorities, including the
FAR if the last known sexual contact with the child was less than 72 hours. Detailed
physical examination of the genital area can also reveal evidence of chronic sexual abuse,
but this should be performed by a pediatrician or other practitioner with expertise in
this area whenever possible. Consultation is certainly indicated if chronic or repeated
trauma to the genital area is in question.
The child's statements in sexual abuse investigations are very important. Any and all
spontaneous comments made by children relating to allegations of sexual abuse should be
carefully documented, preferably word for word (don't interpret or paraphrase). Extensive
questioning, when possible, should be done by a professional trained in sexual abuse
interviews. Ideally, these should be videotaped and transcribed. However, children
sometimes selectively disclose critical information so the medical officer should be alert
to all the communications during a child examination.
The psychological effects of sexual abuse, both acute and delayed are usually troubling
questions for parents and relatives. There are no clear answers. Referral to mental health
professionals with expertise in this area is warranted. When the perpetrator is a family
member, the disclosure usually leads to family crisis. These situations can evolve quickly
and dramatically to additional domestic conflicts. Timely consultation and referral to a
mental health professional is indicated.
Summary
The protection of dependent children who are abused, neglected, or
abandoned has become a high priority for the Department of the Navy. The Family Advocacy
Program established in 1979, has the responsibility and authority to assist commands and
the Medical Department in all child abuse cases. The family advocacy representative at
your command is the best resource.
For questions concerning medical aspects of suspected child maltreatment, the following
consultative service is available;