Sexual assault in children and adolescents is an alarming public health problem. According to the National Sexual Violence Resource Center, 1 in 4 girls and 1 in 6 boys will be sexually abused before they turn 18 years old. Sexual assault victims not only experience physical trauma, but emotional trauma as well. Timely connection to care that addresses both physical and behavioral health needs is critical, as it can alleviate PTSD, anxiety and depressive disorders that often follow sexual assault
Minimizing trauma to young sexual assault victims
Children who are victims of sexual assault have a complex and highly unique set of needs that are best served at a pediatric focused facility. Children’s Hospital of Philadelphia’s Sexual Assault Response Team (SART) is an Emergency Department community-based program dedicated to providing the best clinical care while minimizing further trauma in young sexual assault victims. It is one of the few programs of its kind designed for a pediatric population. Since its inception in 2009, SART has provided care for more than 1,000 pediatric patients from infancy to adolescence, with the youngest patient being just four weeks of age.
“The creation of the SART program has allowed us to provide comprehensive care to patients who reside within our community and beyond,” says Jennifer Molnar, MSN, PNP-BC, nurse practitioner and sexual assault coordinator with SART. “The ultimate objective of SART is to minimize trauma to our young victims while providing them with the most up-to-date care.”
When a child enters Children’s Hospital of Philadelphia’s Emergency Department (ED) as a victim or suspected victim of sexual assault, they are met by a compassionate, experienced team of SART specialists that includes ED nurses, advanced practice providers, child life specialists, social workers, pediatric emergency medicine and trauma physicians, child abuse pediatrics physicians, and special immunology providers.
This expert team is specially trained to care for the complex physical, emotional and psychological needs of these vulnerable children, and works together to streamline the clinical, behavioral, child protection and legal care.
Establishing new standards of care and reporting of sexual assault
The majority of the patients seen by SART are girls younger than 16 years old, brought to the ED within 24 hours of the incident. Alleged perpetrators include family members, non-family acquaintances, dating relationships and unknown abductors. Given the potential for involvement of the court system for these patients, it is crucial that information be collected in a systematic, careful way, and that documentation is clear and thorough.
SART’s uniquely devised sexual assault clinical pathway ensures a standardized approach to evaluation and documentation and provides recommendations for care, screening, treatment and follow-up, including protocols for filing reports with the Department of Human Services and police.
Supporting the entire family in the face of suspected sexual assault
Team members not only assess and care for the medical needs of the patient, but their role also includes:
- Helping caregivers deal with challenging behaviors a child may be exhibiting due to stress and anxiety
- Helping the caregiver/child process and understand medical information
- Helping families navigate the different entities involved, including child welfare, legal and medical systems
- Educating caregivers about typical sexual development
- Improving the quality of communication between caregiver and child about difficult experiences
- Connecting the patient to the appropriate behavioral health resources in the community
Continuing care after the emergency department visit is critical for this patient population, as many children and families have long-term emotional and physical needs. Upon discharge, physicians, social workers and psychologists from Safe Place: The Center for Child Protection and Health (part of the SART team) provide follow-up to sexually assaulted patients. The Child Abuse, Referral and Evaluation (CARE) Clinic — the outpatient clinical service of Safe Place — provides additional trauma-based services.
“To provide seamless care coordination from the ED to follow-up medical and behavioral healthcare, a ‘warm handoff’ is provided from the ED to the Safe Place team,” says Phil Scribano, DO, MSCE, Section Chief of Safe Place. “This process was developed to ensure follow-up needs are met for children and their families. Often, following the initial evaluation, caregivers have questions and often benefit from assistance in navigating the next steps in the care for their child. Our team provides a compassionate, trauma-informed approach to follow-up of medication access and adherence, evaluation of emotional symptoms that may warrant urgent care, and assistance in scheduling follow-up medical and behavioral health needs.”
The next chapter: Advocating for a vulnerable patient population
While great strides have been made, the work of the SART team continues as it seeks to improve the quality of care provided to this high-risk pediatric patient population.
“These problems require us to consistently rethink our approach to care and best practices,” says Molnar. “We believe that with evidence-based training and protocols, strong advocacy, data, and a commitment to improving the proper collection of evidence, we can affect widespread changes in the care of children and adolescents who are victims of sexual assault.”
Areas CHOP clinicians and researchers are focusing on include enhancing communication with law enforcement and social service agencies, as well as establishing sustainable care models that can be replicated in pediatric institutions nationwide — all with the goal of minimizing trauma to young sexual assault victims.