On arrival you and your child will be welcomed by the clinical and support staff. You will be offered refreshments. A history of events leading to your attendance will be taken in a sensitive manner. 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 aiming to identify and address all health needs. Your child will be asked who they wish to support them during an examination. For young children the parent or carer is usually present throughout examination. Examination of the anal and genital areas is 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. Medical samples will be taken to investigate potential infection. 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. 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.
In conclusion of the examination you and your child (if age appropriate) will receive verbal feedback as to any findings and reassurance. Arrangements for follow up or further referral to other medical services will be agreed. You will be given time to ask any questions. A written report will later be prepared for your GP, Social Work and the Gardai (if involved).
You may feel it helpful to view the CASATS – Child Adolescents Sexual Assault Treatment Service pre-attendance video on u tube which demonstrates the process.
In addition, CARI offers Aftercare support service is also available. This service is available to any adult involved in supporting a child’s needs through the forensic process. Our care worker will offer a psychological, informative, empathic, non-judgmental space. The aftercare service is client led and the family can avail of this service for as long as they require.
A child may have many questions regarding their forensic medical examination. It is vital to be honest but not to over overwhelm the child with too much information, and to use appropriate language. Try to stay calm, as the more relaxed you are, the more relaxed your child will be. The following questions are currently frequently asked questions!
Younger child – Infant:
Answer: When a child has disclosed sexual abuse and referred for a forensic examination, it can be explained to the child/young person that they are attending a special doctor because of what they have said happened. They will have a full check-up, including their private areas. To define ‘private’ can be anything in your underpants/nappy.
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 not a test to prove that the event/s did or didn’t occur.
Remember, If there is no disclosure of sexual abuse from child/young person, but you have 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 and to reassure them they have done nothing wrong and that ‘we’ just need to make sure you are ok.
Answer – 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. 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. They 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 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 child. 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. The doctors, nurses and facilities aim to be child friendly.
Answer: Sometimes a needle is used. However, a special (magic cream) is used to numb the skin to reduce soreness.
Answer: 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.