This guide is based on the “Forensic Evaluation Critical Analysis Guide” developed by the National Children’s Advocacy Center for use in Forensic EvaluationT M Training of mental health professionals who conduct extended forensic evaluations of children in cases of suspected sexual abuse. This guide has been modified from the NCAC’s version for consideration by healthcare professionals who conduct medical evaluations of
children and adolescents who are suspected to have been sexually abused.
Precautionary Note (from the NCAC Forensic Evaluation Critical Analysis Guide):
This guide is not an empirically normed scale. It is a desk guide, designed to assist the evaluator in analyzing the results of a forensic evaluation. It is intended to be used as a tool in the process of decision making regarding the obtained information. The presence or absence of any given element does not validate or invalidate allegations, rather, the elements are provided as a framework for the analysis of the evaluation outcome.
Disclosure Factors:
Child made a verbal disclosure of abuse Child provided a demonstration of abuse
Child provided a description of abuse to someone else
Child provided the majority of details in first person perspective Disclosure was somewhat unstructured without a rote quality
Child’s affect was within a range considered congruent with the disclosure Attempts were made to decrease potential coercive elements:
Evaluator clearly communicated to the child that the evaluator lacks knowledge about the child’s experience
Evaluator communicated ground rule to tell the truth, talk about things that really happened and child indicated comprehension
Child demonstrated freedom to correct interviewer Child demonstrated freedom to say, “I don’t remember”
Child demonstrated ability to refrain from guessing Child demonstrated ability to disagree with the evaluator Disclosure is consistent with developmental level:
Details of time are developmentally appropriate Details of location are developmentally appropriate Details of acts described are developmentally appropriate
Identification of alleged offender is developmentally appropriate
Sexual knowledge and/or terminology is beyond the typical developmental level for age
General terminology describing alleged offense is consistent with child’s typical language
Oregon Medical Guidelines Chapter 15 pg 8 Specific details recounted (taking into consideration child’s developmental capabilities):
Alleged offender clearly identified
Identified general timeframe / date / time of day abuse occurred Identified where offense(s) took place
Provided sensory details
Provided unique or idiosyncratic details
Provided contextual details (decorations, pieces of furniture) Described props (e.g., lotions, porn, photography, or gadgets) Identified grooming behavior
Described maintenance of secret or offender’s use of force, threats, coercion Described specifics of own clothing
Described specifics of alleged offender’s clothing Pattern of abuse is plausible
Core factors are identified consistently
Child provided quotes of statements made by self or alleged offender
Child described own or alleged offender’s emotional state during alleged offense Child attempted to justify alleged offender’s actions
Corroborative Information/Confirmatory Factors:
Physical findings indicate possibility abuse occurred Law enforcement has crime scene evidence
Alleged offender confessed
Witness corroboration has been obtained
Other victims of alleged perpetrator have disclosed
Alleged offender has previously been investigated by law enforcement/CPS Alleged offender has previously been convicted of child abuse
Motivational Factors:
Likelihood of possible secondary gain low Likelihood of coaching by caregiver low
Child’s explanation of present disclosure has been explored Alternative Explanations :
Evaluator ruled out possibility of specific psychiatric disorder which impairs perceptions of reality
Evaluator ruled out possibility that benign activity (e.g., bathing) was misinterpreted
Evaluator ruled out likelihood of third party influence
Evaluator ruled out likelihood of other explanatory dysfunction in child’s life Evaluator found adequate explanations for any unusual or improbable elements
CLASSIFICATION GUIDE FOR THE
MEDICAL DIAGNOSIS OF CHILD SEXUAL ABUSE PART I: Physical and Laboratory Findings
NORMAL/NORMAL VARIANTS/ labia, perihymenal tissues, posterior fourchette, perineum, penis or scrotum
• scar—post-fourchette or posterior fossa
• bite mark, bruise, “hickey” on inner thighs near genitalia
• dilation > 20mm OR markedly irregular anal orifice [with no stool in rectal vault, no bowel movement past 30 minutes, no historyofchronicconstipation/encopresis, no sedation or neuro deficits]
• perianal laceration deep to the external anal sphincter
• HSV I and HSV II anogenital lesions
• anogenital HPV (Condyloma acuminata)
• positive sperm or seminal fluid in/on child’s body
*Given no clear, timely, plausible history of accidental injury or of perinatal or other non-sexual transmission of infection.
**For STD’s—please refer to the STD chapter for guidelines on “ruling out” other modes of transmission and testing recommendations.
Regional Training and Consultation Center at CARES NW
(6/21/04)
OR Med Guidelines Chap 15 pg 9
CLASSIFICATION GUIDE FOR THE
MEDICAL DIAGNOSIS OF CHILD SEXUAL ABUSE PART II: Diagnostic Classification—Medical Diagnosis
No indication of sexual abuse
• normal or nonspecific physical and laboratory findings AND --child without disclosure of abuse
--child with no or nonspecific behavioral changes
--another known or likely explanation for nonspecific physical findings
• anogenital findings which are accounted for by accidental injury, the history of which is clear and consistent Sexual abuse possibleèhighly likely
• normal or nonspecific physical and laboratory findings AND --child without disclosure of abuse
--BUT child with sexualized behaviors or at high risk for sexual abuse
• normal or nonspecific physical and laboratory findings AND --child makes disclosures of abuse
--BUT disclosure is not detailed, not consistent or is obtained using leading questions
• concerning physical or laboratory findings AND --child without disclosure of abuse
• normal, nonspecific or concerning physical and laboratory findings AND --child without disclosure of abuse
--BUT adult witnesses abuse OR individual confesses to sexually abusing child Diagnostic of or conclusive for sexual abuse
• child has normal, nonspecific or concerning physical and laboratory findings AND --child gives spontaneous, clear, consistent, detailed description of abuse --alternative hypotheses evaluated and ruled out
• physical findings which are clear evidence of abuse or penetrating trauma AND --child is without a history of accidental penetrating trauma
• laboratory findings which are diagnostic for abuse, other modes of transmission ruled out
• photographs/video showing child being sexually abused AND
--after law enforcement investigation, photos deemed unaltered
Regional Training and Consultation Center at CARES NW
(6/21/04)
OR Med Guidelines Chap 15 pg 11
Oregon Medical Guidelines Chapter 16 pg 1