Clinical Judgment Regarding Suspicion of Child Sexual Abuse: A Pilot Study of Factors Associated with Differential Levels of Clinician Concern

Thesis advisor: Thomas M. CreaChild sexual abuse is a major public health problem in the United States, but identifying risk, especially in young children with suspicion of abuse, poses many challenges. The aim of this study is to understand how clinicians judge the possible presence of sexual abuse in children where serious suspicion exists but without substantiated abuse. This study used data from randomly selected sexual abuse and trauma evaluations of preschool and school-aged children presenting to Boston Children’s Hospital (BCH) Outpatient Child Protection Program between 2000-2007 (N=100) to examine the association between child and family risk factors and level of clinician concern regarding likelihood of child sexual abuse. Multi-nomial logistic regression analysis was used to examine the relationship between child and family risk factors and level of clinician concern regarding suspicion of abuse, moderated by child’s gender and age. Results indicated that a child’s disclosure and trauma presentation were the key factors that clinicians considered within the higher level of clinician concern regarding likelihood of sexual abuse. Implications for future research and clinical practice include attention to methodology research to assist with the development and validation of assessments for evaluation of risk in complex cases of suspicion of sexual abuse that can be offered in clinical setting, without sole reliance on the child’s ability to disclose in order to access help. Additionally, it is essential that research focuses on the development of clinical models to help with clinical decision making protocols in ambiguous cases of sexual abuse with children who may not be in a position to disclose, but serious concerns have been raised, with focus on increasing their safety. The findings in this research strongly suggest that it is essential to continue to focus on assisting children who present with suspicion of sexual abuse in complex cases that do not fit neatly into our current forensic and child protective services systems. This is especially necessary with the most vulnerable children where disclosure is unlikely, but clinical evaluations can yield recommendations that maximize efforts at increasing safety, child mental health, and family cohesion, and build on strengths while simultaneously accounting for risks.Thesis (PhD) — Boston College, 2015.Submitted to: Boston College. Graduate School of Social Work.Discipline: Social Work