Triage and referrals for child sexual abuse medical examinations from the sociolegal system

HEALTH CARE PROVIDERS and sociolegal professionals an confronted daily with possible sexual abuse of a child sind what may be the best course of action for medical evaluation. Does this child need a medical exam? Who should provide the medical exam? When and where should it be performed? In many circumstances these questions are answered on a gut, experiential level with little scientific evidence to direct an appropriate response. In addressing triage and referral, the underlying challenge is the assurance of the best possible outcome. Is the right thing being done at the right time? What is the best care for which purpose? Which children need and benefit from referral to medical care? What settings for medical care provide better outcomes for which children? What level of medical expertise does the sociolegal system need? How is outcome determined by the differing individuals with a stake in the process-the child, family, health care provider, or sociolegal professional? This paper will review the limited research on triage and referral for child sexual abuse medical examinations, identify unanswered questions, propose a framework and make recommendations regarding future research to guide practices. Developing a research agenda to assess triage and referral for medical evaluation is quite a task, largely because the issues are so numerous and confounded, and the various consumers may have differing agendas. The science of sexual abuse evaluations is being addressed by others in this journal issue-the behavioral and medical consequences, normal anatomy, diagnosis of trauma, STDs, emotional impact of exams, and the impact on the sociolegal system. These collective findings and recommendations provide the foundation for making recommendations about triage and referral. Incorporating sexual abuse science into the model of the Medical Outcomes Study assessing structure of care, process, and outcomes (Tarlov et al., 1989) will facilitate assessment of the broader picture-what is the best recommendation for medical evaluation in a given set of circumstances?