Why do I need a forensic medical examination?
A child may have many questions regarding their forensic medical examination. It is vital, to be honest, but not to over overwhelm your child with too much information, and to use appropriate language. Try to stay calm, as the more relaxed you are, the more comfortable your child will be.
Younger child – Preverbal:
If a child has disclosed sexual abuse – explain to the child that they are attending the special doctor because of what the alleged (person’s name) has done. They will have a complete check-up, including their private areas. To define ‘private’ anything in your underpants/nappy is private.
If there is no disclosure of sexual abuse but concerns, or a child who has been at risk of abuse:- Explain that they are going to a special doctor for a check-up of their whole body, including private parts. To reassure the child, they have done nothing wrong and that ‘we’ just need to make sure they are ok.
If a child has disclosed sexual abuse – explain to the child that they are attending a medical doctor because of what the alleged (person’s name) did. They will have a full check, head to toe including private areas and will have some special tests done to make sure there is no infection. Reassure them they have done nothing wrong and that ‘we’ just need to make sure you are ok. Reassure your child that this (is) not a test to prove that the event/s did or didn’t occur.
If there is no disclosure of sexual abuse but concerns or a child who has been at risk – Explain that they are attending the medical doctor in the unit for a full check, head to toe including private areas. To reassure them they have done nothing wrong and that ‘we’ just need to make sure you are ok.
Do I have to go ahead with the forensic medical examination?
No. A child should not be forced to undergo an examination but can be supported and encouraged to do so with appropriate reassurance. When a child attends the sexual assault treatment unit, it is because there is a concern or disclosure of sexual abuse. An examination is therefore offered in the best interests of the child to address health needs, provide clinical reassurance, and access any forensic evidence that may be present. The child/young person will never be forced to undergo a forensic procedure if they do not consent. Both parents or legal guardians of the child/ren also must give consent.
Whilst at least one parent or legal guardian and older children who have a capacity to understand the process give written consent for examination after full explanation, the extent of any examination can be negotiated depending on the needs and wishes of the child. The doctors, nurses and facilities aim to be child friendly. The clinic has age-appropriate toys and DVD’s. A parent or carer is encouraged to remain with the child throughout examination if the child wishes. The child or carer can determine that the examination be stopped at any time.
Will there be a needle ? Will it hurt?
Sometimes a needle is used. However, a special (magic cream) is used to numb the skin to reduce soreness.
What happens when a child receives a forensic medical examination?
Arrangements will be made with you directly or through the Gardai or Tusla social workers to attend the Sexual Assault Treatment Unit in Galway on a specific date and at a specified time. Directions will be given, and telephone contact details supplied. Your child/children will be the only patients in the unit. Your privacy is paramount.
On arrival, you and your child will be welcomed by the clinical and support staff. You will be offered refreshments and given time for your child to become familiar with the unit. A history of events leading to your attendance will be taken sensitively. Depending on the age and needs of your child, this may be done in privacy whilst your child is engaged in play in another area or, if old enough, your child may choose to be involved in or lead in this process.
A full medical history is taken. Details are recorded in handwritten notes. A top to toe examination of your child is undertaken to aim to identify and address all health needs. Your child will be asked whom they wish to support them during an examination. For young children, the parent or carer is usually present throughout the examination. Examination of the anal and genital areas are photographed using specialised equipment. This will record important physical signs if present, which may inform court processes and usually avoids the need to have your child examined again.
Forensic samples may be taken if the abuse has happened within the previous 3 -7 days (forensic evidence will not be present after 7 days). Medical samples will be taken to investigate potential infection(s). Samples may include hair combing, nail clipping, cotton-tipped swabs rolled onto skin surfaces, urine and/ or blood samples. Pre-pubertal children do not have internal examinations. The Examination should not be uncomfortable. Adolescents can decide whether or not they wish for an internal examination.
Skin marks such as bruises, scars, and cuts will be documented on hand-drawn body diagrams. Your child may be offered medication to prevent infection and vaccination against Hepatitis B if they have not previously been vaccinated.
After the examination, you and your child (if age appropriate) will receive verbal feedback on any findings and reassurance. Arrangements for follow-up or further referral to other medical services will be agreed upon. You will be given time to ask any questions. A written report will later be prepared for your GP, Social Work, and the Garda (if involved).
You may feel it helpful to view the CASATS pre-attendance video on YouTube which demonstrates the whole process for one family in real-time.
How long does the overall process take?
The entire appointment can take up to 3 hours, for one child. This includes a medical history of the child/ren and a forensic examination.
What support is available?
The doctor, nurse and administrative staff are highly specialised in the area of child sexual abuse and aim to be sensitive and supportive to you from the first point of contact throughout your engagement with this service. A.S.S.C. provides forensic accompaniment officers, who will be there for you in the unit on the day of examination to offer you and your family support.
A.S.S.C.’s Aftercare support service is also available. This service is available to any parent/career who is involved in supporting a child’s needs through the forensic process. Our care worker will offer a psychological, informative, empathic, non-judgmental space.
How long does the overall process take?
The entire appointment can take up to 3 hours, for one child. This includes a medical history of the children/young people and a forensic examination.
How long can I receive Advocacy Phone support?
The aftercare service has a client-led approach, which allows the family to avail of this service for as long or as short as they need. We will always direct you to more appropriate services if needed. That is part of what we do.
Frequently Asked Questions relevant to A.S.S.C.
Does A.S.S.C charge for its services?
No. A.S.S.C. does not cost anything for children and their families.
Does A.S.S.C. provide services to children who need wheelchair access or other particular needs?
Yes, A.S.S.C. provides services to every child in need within the working territory. Make contact with us and we will make provisions for you and your child. Some of our volunteers have vast experience supporting people with disabilities and/or autism.
What should I do if I suspect child abuse?
Child abuse should always be taken seriously, if you suspect possible abuse, you must disclose this information to the authorities An Garda Síochána and Tusla without delay. A series of patterns is the most reliable indicator of abuse. Before you act on your concerns, consider the following:
- Is there any other reason why the young person might be behaving in a particular way?
- Is the child behaving normally for his/her age and stage of development?
- Did you or anyone else see what happened?
- Is the child showing signs of distress, and how? Is the child suffering?
- Could injuries or signs be caused another way?
- Is there a pattern to this type of occurrence?
- Has the young person said anything to indicate that he/she is being harmed?
If you have considered these questions and are still concerned. You must take further action.
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What are some indicators of abuse in children?
Most signs of abuse are not specific, it is important to consider if your child is acting in an unusual way or out of character. This may be the most compelling indicator.
- Disclosure of abuse and neglect by a young person
- Age-inappropriate or abnormal sexual play or knowledge
- Specific injuries or patterns of injuries
- Absconding from home or a care situation
- Suicide Ideation and/or attempted suicide
- Underage pregnancy or sexually transmitted disease
- Signs of one or more of the indicators above
Journey through the Criminal Justice System
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