Title Medical Response to Child Sexual Abuse, 2/e
Subtitle A Resource for Professionals Working with the Children and Families
Author Randell Alexander, Nancy Sanders Harper
ISBN 9781936590742
List price USD 110.00
Price outside India Available on Request
Original price
Binding Paperback
No of pages 522
Book size 178 x 254 mm
Publishing year 2019
Original publisher STM Learning (Eurospan Group)
Published in India by .
Exclusive distributors Viva Books Private Limited
Sales territory India, Sri Lanka, Bangladesh, Pakistan, Nepal, .
Status New Arrival
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“Professionals working in the field of child sexual abuse have an important task. They should be dedicated to help abused children and their families in the best possible way. This means that talking to children, performing the examination and tests, interpreting findings and results, and providing therapy should be based on best practice and scientific evidence. This text offers an excellent evidence based resource for the complete workup of sexually abused children in a multidisciplinary approach. This book also provides information about abused children with disabilities, child sexual exploitation, prevention, and the court process. Every professional working in this field should be familiar with this textbook.”

Wouter A. Karst, MD, Forensic Physician, Netherlands Forensic Institute, The Hague, Netherlands


“A valuable text for medical providers (physicians, forensic nurses, and advance practice providers) whether novice or expert, who provide care to children, adolescents, and their families when there is a suspicion of sexual abuse. Dr. Finkel provides meticulous detail describing elements of the medical history, components of the examination, screening for trauma symptoms, the value of anticipatory guidance on personal space and safety, and the mandate for precise and accurate medical documentation. An updated review is summarized regarding the collection and testing of items with potential evidentiary value with a forward focusing lens. Dr. Kellogg contributes a thorough blueprint on the testing, imaging, treatment, and reporting of STIs in addition to a valued approach to providing care to adolescents with concerns of sexual abuse. Dr. Nazer provides a detailed course on the structures of the genitalia and Dr. Adams provides the most recent information regarding the interpretation of medical findings in suspected child sexual abuse. This book is valuable to all members of the multidisciplinary team providing care, comfort, investigation, guidance, and resolution for children and adolescents affected by child sexual abuse.”

—Sonja Eddleman, MSN, RN, SANE-A, SANE-P, Child Abuse Resource and Evaluation (CARE) Team, Clinical Coordinator, Driscoll Children’s Hospital, Corpus Christi, Texas


“Readers across multiple disciplines—including healthcare providers, social workers, child protection teams, legal professionals, and law enforcement—will find this text highly relevant. The necessity of a multidisciplinary team to optimally care for children who have experienced sexual abuse and recommendations for the role of each team member are outlined. All disciplines will find practical applications for the information in chapter 3: “The Medical Evaluation of a Suspected Child Abuse Victim.” This chapter details key elements to approaching the child victim and family, the specifics of the history and physical exam, and highlights legal aspects of documentation with specific examples provided. Notably, this text ends with a review of the effects of sexual abuse on the genetic/epigenetic level of the brain and highlights the long term psychological and health consequences. For all who care for children and families affected by sexual abuse, I highly recommend this text as an engaging and thorough resource.”

—Kelly C Dauk, MD, Professor of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky


“Dr. Alexander and Dr. Harper provide a bright and fast-moving discussion covering a wide expanse of multidisciplinary history, describing society’s concept of the disease of child sexual abuse around the globe. The chapter maintains an optimistic tone even in the realistic criticism of past missteps and frames goals for the future of the field. Dr. Liker and Dr. Thackeray give an informative review addressing the application of evidence-based medicine criteria to the Child Abuse Pediatrics literature with a clever use of well-known publications for analysis of individual concepts. This chapter flows easily, reminiscent of participation in a journal club, and provides a grounded discussion that can (and no doubt will!) be referred to repeatedly by readers.”

—Marcella Donaruma, MD, FAAP, Associate Professor of Pediatrics, Baylor College of Medicine, Section of Public Health Pediatrics, Texas Children’s Hospital, Houston, Texas


“This comprehensive digest offers a concise assimilation of chapters summarizing the latest research on child abuse practice for both advanced and beginner medical providers and multidisciplinary team members. Covering a broad range of topics with ample illustrations, this text will likely become the go-to resource on the shelves of child advocacy centers. In addition to a descriptive examination technique chapter, Dr. Harper provides useful explanations on the necessity of the non-acute examination beyond the forensics. The chapter on the importance of the post-examination conference offers lists and questions that are a must-read for practitioners and CAC family advocates. The chapter on therapy explains the unique effectiveness and application TF-CBT and the importance of parental engagement. Emphasizing how prevention efforts must move beyond child-based training, the prevention chapter describes new trends. Beyond child abuse pediatricians and medical providers, this book offers valuable information for all members of the multidisciplinary team.”

—Stacie LeBlanc, MEd, JD, Executive Director, New Orleans Children’s Advocacy Center, Department Head, Audrey Hepburn CARE Center, Children’s Hospital of New Orleans, New Orleans, Louisiana


The second edition of Medical Response to Child Sexual Abuse is revised and updated to reflect contemporary best practices for the pediatric approach to childhood sexual abuse. This text is specifically developed to equip physicians, nurses, and other medical professionals with the necessary tools to identify cases of child sexual abuse and to effectively treat and examine sexually abused patients.

Professionals who work with sexually abused children face a great challenge in not only treating the immediate outcomes of sexual abuse but also safeguarding their patients’ long-term recovery. To meet their needs and the needs of those in their care, Medical Response to Child Sexual Abuse, Second Edition offers a wealth of evidence-based research and practical guidelines to the evaluation of childhood sexual abuse.


Chapter 1. The Medical Response to Child Sexual Abuse: An Historical Overview • Introduction • Not Just a Human Issue • From the Dawn of Civilization • The Early Medical Response • The Modern Response • The Role of Law Enforcement • Scientific Advances • Medical Care of the Child Abuse Victim: Now and Beyond • Conclusion • References

Chapter 2. Basic Anatomy of the Genitalia and Anus • Introduction • Embryology • Normal Variations • The Hymen • The Clitoris • The Anus • Effects of Puberty • The Hymen • The Vagina • The Cervix • Conclusion • Appendix 2-1: Features of Genital and Anal Anatomy • References

Chapter 3. The Medical Evaluation of a Suspected Childhood Sexual Abuse Victim • Introduction • Presentations for Care of Suspected Child Sexual Abuse • Sources of Information in Suspected Sexual Abuse Cases • Talking to Children and Adolescents About Sexual Abuse • Purpose of the Medical Examination • Components of the Medical History in Cases of Suspected Sexual Abuse • Review of Systems • Screening for Trauma Symptoms • Preparing Caregiver and Child for the Physical Examination • Conducting the Physical Examination • After the Examination: Anticipatory Guidance on Personal Space and Safety • Addressing the Psychological Impact of Sexual Abuse • Trauma-Focused Cognitive Behavioral Therapy • Body Safety Education • Medical Record Documentation in Cases of Suspected Child Sexual Abuse • Special Medicolegal Considerations for Medical Record Documentation • Formulating a Diagnosis • Conclusion • References

Chapter 4. The Medical Evaluation of Acute Sexual Abuse or Assault in Children and Adolescents • Introduction • Medical Evaluation Process • Medical History • The Physical Examination • Forensic Evidence Collection • Steps in Collecting and Documenting Forensic Evidence • Alternative Light Source Illumination • Recommended Testing for Sexually Transmitted Infections and Pregnancy • Drug-Facilitated Sexual Assault • Findings and Interpretation • Physical Injury Interpretation • Non-Anogenital Trauma • Genital Trauma • Consensual Sex • Anal Trauma • Bite Marks • Physical Injury in Prepubertal Children • Examination Findings Indicative of Abuse • STIs as Evidence • Forensic Evidence Interpretations • Spermatozoa • Prostatic Acid Phosphatase and Other Seminal Fluid Markers • Trace Evidence • Hair and Fiber Analysis • Clothing Evidence • Role of Forensic Evidence in Proving the Identity of the Perpetrator • Forensic Evidence in Children • Relationship of Physical and Forensic Evidence to Successful Prosecution • Medical Management Considerations • Conclusion • References

Chapter 5. The Sexual Abuse Postexamination Conference With Families • Characteristics and Goals of the Postexamination Conference • Conference Participants • Conference Procedures • Medical Aspects • Psychosocial Aspects and Crisis Intervention • Disclosure and Its Reliability • Conflict With Relatives • Safety of the Child • The Child’s Behavior • The Investigation • Examination Findings • Evaluation of the Child’s Psychological Distress • Family Support Structure • Adverse Childhood Experiences • Intimate Partner Violence • Parental Substance Abuse • Ending the Conference • Prevention of Conference Problems • Follow-Up • Research Needs • Conclusion • References

Chapter 6. Non-Emergent Medical Examination Procedures and Techniques • Introduction • Indications for Medical Assessment • The Medical Examination: Setting the Scene • Examination Positions and Techniques • Examination Positions • Supine Frog-Leg Position • Supine Lithotomy Position • Prone Knee-Chest Position • Supine Knee-Chest Position • Lateral Decubitus Position • Examination Techniques • Photodocumentation • Methods of Photodocumentation • Discussion of Findings With Children and Parents • Conclusion • References

Chapter 7. Evidence-Based Approach to Child Sexual Abuse Examination Findings • Introduction • Methodology Soundness and Result Validity • Case-Control Studies • Cross-Sectional Studies • Case Reports and Case Series • Review Articles and Summary Reports • Assessing Study Validity • Regarding Study Population • Regarding Study Methodology • Useful Patient Differentiation • Applying Study Results to Patient Care • Reviewing the Literature Regarding Child Sexual Abuse Examination Findings • Review of Cross-Sectional Study • Methods • Methods Discussion • Results • Review of Case-Control Study • Methods • Methods Discussion • Results • Review of Case Series • Methods • Methods Discussion • Conclusion • References

Chapter 8. Interpretation of Genital and Anal Findings in Children and Adolescents With Suspected Sexual Abuse: State of the Science • Introduction • History • Studies in Genital and Anal Findings in Children and Adolescents With Suspected Sexual Abuse • Research • Hymenal Data • Sexually Transmitted Infections • Mimics • Anal Dilation • Injuries • Conclusion • Appendix 8-1: Normal Variations and Forensic Photography • References

Chapter 9. Medical Conditions That Mimic Sexual Abuse • Introduction • Medical Mimics of Child Sexual Abuse • Genital Irritation/Erythema • Anogenital Bruising • Lichen Sclerosus • Hemangiomas/Vascular Malformations • Purpura as a Mimic of Bruising • Accidental Genital Injuries • Skin Discolorations from Dyes, Surgical Adjuncts, and Plants • Bleeding • Skin • Maceration with Irritant Contact • Urinary Tract • Perivaginal • Group A ß-hemolytic Streptococci • Vaginal Bleeding • Shigella Vaginitis • Endocrine Causes • Newborn Withdrawal Bleeding • Prepubertal Menarche • Precocious Puberty • Vaginal Foreign Body • Neoplasms • Bleeding of Gastrointestinal Origin • Fissures • Perianal Bleeding • Discharge • Nonvenereal Pathogens • Papules, Macules, and Nodules • Papules and Nodules • Molluscum Contagiosum • Perianal Pseudoverrucous Papules and Nodules • Vesicles and Ulcers • Conclusion • References

Chapter 10. Sexually Transmitted Infections • Introduction • Considerations for Sexually Transmitted Infection Testing • Neisseria Gonorrhoeae and Chlamydia Trachomatis • Human Papillomavirus • Trichomonas Vaginalis • Herpes Simplex Viruses • Syphilis (Treponema Pallidum) • Human Immunodeficiency Virus • Hepatitis A, B, and C • Bacterial Vaginosis • Testing the Suspect • References

Chapter 11. Collection and Testing of DNA Evidence • Introduction • Evidence Collection • Touch DNA Samples • Contamination Prevention • Serological Laboratory Analysis • Semen • Saliva • Blood and Hair • Evidence Testing Triage • Untested Sexual Assault Kits • Forensic DNA Testing Procedure • DNA Extraction • Polymerase Chain Reaction/Amplification • DNA Quantification • Interpretation of Quantitation Results • Autosomal Short Tandem Repeat Multiplex • DNA Detection • DNA Conclusions • Combined DNA Index System • Y Chromosome STR Multiplex • Mitochondrial DNA Testing • Emerging Techniques • Further Research • Conclusion • References

Chapter 12 . Child Sexual Abuse Medical Examiners • Importance of the Sexual Abuse Evaluation • Knowledge and Reliability of Examiners About Sexual Abuse • Purpose of the Medical Evaluation of Sexual Abuse • Collection of Evidence and Protection of the Child • History Taking • Photodocumentation • Collaboration Between Health Professionals • Who Examines Children for Sexual Abuse? • Training and Education • Experts • Ongoing Education • Conclusion • References

Chapter 13. The Multidisciplinary Team and Child Sexual Abuse • Background and Rationale • Members of the Multidisciplinary Team • Child Protective Services • Law Enforcement • The Courts • Mental Health • The Health Care Provider • Multidisciplinary Team Function • Conclusion • References

Chapter 14. Child Sexual Abuse: An International Perspective • Introduction: Commercial Sexual Exploitation of Children • Definitions • Child • Child Marriage • Child Labor • Slavery: Forced Labor, Serfdom, and Debt Bondage • Child Trafficking • Commercial Sexual Exploitation • Sexual Exploitation of Children in Travel and Tourism • Sexual Exploitation of Children in/for Prostitution • Use of Children for Sexual Performances • Child Soldiers • Scale of the Problem • Child Marriage • Child Labor, Trafficking, and Sexual Exploitation • Contributing Factors • Birth Registration • Age, Gender, and Other Individual Factors • Poverty and Education • Family • Setting • Cultural Factors • Armed Conflict • Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome • Getting Involved in Commercial Sexual Exploitation of Children • Economics • Consequences of CSEC • Interventions • Conclusion • References

Chapter 15. Adolescent Issues in Sexual Abuse and Assault • Introduction • Definitions and Victim Perceptions of Abuse Experiences • Clinical Presentations • Clinical Evaluation • Medical History • Tell Them Your Agenda • Earn Trust • Assure Safety • Family History, Support by Nonabusive Parent, Protection of Abuser, or Concern for Integrity of Family • Health-Risky Behaviors • Medical Issues • Medical Examination • Head-to-Toe Examination • Evidence Collection • Assess for Body and Oral, Genital, and Anal Injuries • Lessen Embarrassment and Anxiety by Keeping Parts of Body Not Being Examined Draped • Testing for STIs, Pregnancy, Drugs, and Alcohol • STI Testing • Other Diagnostic Tests • Healing • Documentation • Conclusion • Appendix 15-1: The CRAFFT Interview • References

Chapter 16. Child Sexual Exploitation • Introduction • Types of Child Sexual Exploitation • Child Sex Trafficking • Child Exploitation in Prostitution • Child Sexual Exploitation Materials (Formerly “Child Pornography”) • Solicitation of a Child for Sexual Purposes (“Grooming”) • Exploitation in Context of Travel or Tourism (Formerly “Sex Tourism”) • Live Sexual Performances (Online Child Sexual Exploitation or Live Performances in Sexually Oriented Businesses) • Adverse Effects of Child Sexual Exploitation • Prevention of Child Sexual Exploitation • Conclusion • References

Chapter 17. Child Sexual Abuse of Children With Disabilities • Introduction • Epidemiology • Incidence • Risk Factors • Clinical Presentation of Child Sexual Abuse • Behavioral Indicators • Physical Signs and Symptoms • Disclosure by the Child • Specific Disabilities • Hearing Disability • Visual Impairment • Motor Disabilities • Epilepsy • Intellectual Disability • Autism Spectrum Disorders • Communication Disabilities and Augmentative and Alternative Communication • Interview Techniques • Conducting the Interview • Closing the Interview • Post Interview • Standard Procedure and Documentation • History • Physical Examination • Multidisciplinary Team Evaluation • Treatment • Psychological Post-Trauma Treatment • Prevention • Societal Reponses to the Abuse of Children and Adults With Disabilities • Future Efforts • Conclusion • Appendix 17-1 : Recommended Language Use When Discussing or Writing About People With Disabilities or Those Who are Deaf or Hard of Hearing • Introduction • Meeting and Interacting With Persons With Disabilities • Persons With Physical and/or Mobility Disabilities • Persons Who are Blind or Have Visual Disabilities • Persons With Speech and/or Communication Disabilities • Persons Who are Deaf or Hard of Hearing • Persons With Learning Disabilities • Persons Who Have Developmental or Intellectual Disabilities • Persons Who Have Acquired/Traumatic Brain Injury • Persons With Mental Health or Psychiatric Disabilities • Persons With Hidden Disabilities • References • Additional Reading and Resources

Chapter 18. The Medical Professional’s Guide to Court Process and Procedures • Introduction • The Legal System • A Practical Guide to Testifying in Court • Formal Rules • Informal Rules • References

Chapter 19. The Adverse Effects of Sexual Abuse • Harms of Sexual Abuse • Mechanisms of Harm • Genetics • Epigenetics • Effects on the Brain • Long-Term Effects • Adverse Childhood Experiences (ACEs) • Intergenerational • References

Chapter 20. Therapy for the Child Sexual Abuse Victim • Introduction • Sequelae of Child Sexual Abuse • Cognitive Symptoms • Emotional Symptoms • Behavioral Symptoms • Relational Symptoms • Engagement of Families in Therapy • Responsibilities of Referring Practitioners and Families • Responsibilities of Mental Health Practitioners • Clinical and Empirical Literature on the Treatment of CSA • Empirical Reviews of Efficacious Treatments for Sexual Abuse • Treatment Description of TF-CBT and Its Components • Psychoeducation and Parenting Skills • Goals of Psychoeducation • Application of Psychoeducation • Goals of Parenting Skills • Application of Parenting Skills • Relaxation and Stress Management Skills • Goals • Application • Affective Expression and Modulation Skills • Goals • Application • Cognitive Coping and Processing Skills: the Cognitive Triangle • Goals • Application • Trauma Narration and Processing • Goals • Application • Sharing the Trauma Narration with the Parent • In Vivo Mastery of Trauma Reminders • Goals • Application • Conjoint Parent-Child Sessions • Goals • Application • Enhancing Future Safety and Development • Goals • Application • Conclusion • References

Chapter 21. The Path to Prevention • Introduction • The Problem of Child Sexual Abuse and the Importance of Prevention • Defining Prevention • Risk and Protective Factors • Some Key Points to Understand About Sexual Abuse of Children • Discovery of Child Sexual Abuse: More of a Process Than an Event • Children React in a Wide Variety of Ways After Victimization • Parents Are Central for Both Successful Prevention and Intervention • Some Children Are More Vulnerable to Child Sexual Abuse • History of Child Sexual Abuse Prevention Efforts • Educational Efforts Targeting Children • Educational Efforts Targeting Adults • Concerns About Sexual Abuse Prevention Efforts • Prevention Today: Trends and Future Directions • Set Standards and Use Best Practices • Meaningfully Involve Parents • Broaden the Targets of Prevention Messages • Support Quality Education of Children • Create Diverse Approaches for Diverse Communities • Address the Internet and Media • Organizational Interventions • Involve Health Professionals in Prevention Efforts • Ten Steps Health Care Professionals Can Take to Prevent Child Sexual Abuse • Conclusion • References


About the Authors:

Randell Alexander is a professor of pediatrics at the University of Florida and the Morehouse School of Medicine. He currently serves as chief of the Division of Child Protection and Forensic Pediatrics and interim chief of the Division of Developmental Pediatrics at the University of Florida-Jacksonville. In addition, he is the statewide medical director of child protections teams for the Department of Health’s Children’s Medical Services and is part of the International Advisory Board for the National Center on Shaken Baby Syndrome. He has also served as vice chair of the US Advisory Board on Child Abuse and Neglect, on the American Academy of Pediatrics Committee on Child Abuse and Neglect, and the boards of the American Professional Society on the Abuse of Children (APSAC) and Prevent Child Abuse America. Randell Alexander has served on state child death review committees in Iowa, Georgia, and Florida, and two regional child death review committees. He is an active researcher, lectures widely, and testifies frequently in major child abuse cases throughout the country.

Nancy Sanders Harper is the Medical Director for the Otto Bremer Trust Center for Safe & Healthy Children at University of Minnesota Masonic Children’s Hospital and Hennepin Healthcare. Dr. Harper is board certified in Pediatrics and subspecialty certified in Child Abuse Pediatrics. Dr. Harper graduated from Geisel School of Medicine at Dartmouth in 1995, and completed her pediatric residency in 1998 at Naval Medical Center Portsmouth in Virginia. After graduation, Dr. Harper served as a staff pediatrician and child abuse consultant for Naval Medical Center Portsmouth and US Naval Hospital Okinawa in Japan. In 2004, Dr. Harper resigned from the US Navy and entered into fellowship training in Forensic Pediatrics at Brown University in Rhode Island, graduating in January 2007. Dr. Harper then served as the Medical Director for the CARE Team at Driscoll Children’s Hospital in Corpus Christi, Texas from 2007 through 2014. Dr. Harper served on the Committee on Pediatric Centers of Excellence (79th Legislature) tasked with the development of guidelines for designating regional centers of excellence for child abuse in Texas. Governor Perry appointed Dr. Harper to the statewide Blue Ribbon Task Force to Reduce Child Abuse and Neglect (81st Legislature SB 2080) and the Task Force to Reduce Child Abuse and Neglect and Improve Child Welfare (82nd Legislature SB 1154). The Task Force was legislatively charged with addressing child abuse prevention and the promotion of child well-being for the state of Texas. Dr. Harper served as the programming chair for the AAP Section on Child Abuse and Neglect (SOCAN) from 2012 through 2017 and is invested in improving educational opportunities on child maltreatment both nationally and internationally.

Target Audience:

This text is specifically developed to equip physicians, forensic nurses, sexual assault nurse examiners, sexual assault forensic examiners, emergency nurses, nurse practitioners, nursing students, physicians, emergency physicians, medical students, physician assistants, victim advocates, and other medical professionals with the necessary tools to identify cases of child sexual abuse and to effectively treat and examine sexually abused patients.


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