‘I felt like I was the one in trouble.’ Collecting evidence after sexual assault can be scary for children – and the system needs to improve

Source: The Conversation (Au and NZ) – By Caroline Whitehouse, PhD Candidate, School of Psychology & Public Health, La Trobe University

The 72 hours after the sexual assault of a child can be a crucial window for police to collect biological evidence and document signs of bruising or injury.

But this procedure – known as a forensic medical examination – can be scary and invasive.

In new research published with colleagues, I interviewed ten children (aged 4-16) and their parents about their experiences attending a Melbourne paediatric hospital in the hours after an alleged assault.

This was a small group, but their stories shed light on wider concerns. Addressing them can help put children first in what may be the most traumatic time of their lives.

What is a forensic medical examination?

A forensic medical examination can be done in the 72 hours following a child sexual assault.

Its purpose is to gather biological evidence from the victim to help police identify an offender and prosecute them.

At a hospital crisis care suite, the child will speak to a specialist doctor (a forensic paediatrician) alongside another clinician, usually a psychologist or social worker. Police also attend.

The doctor will take the child’s medical history, as well as asking for an account of the assault.

The doctor swabs relevant areas – such as the child’s vulva, vagina or anus – to collect biological materials that may be present, including saliva or semen. They will also look for injuries or bruising.

This examination can be uncomfortable and can take hours. It may also be emotionally harrowing, for the child as well as their carer.

In the following days, children often need to give another statement to police and are referred for counselling.

Understanding how to avoid retraumatisation

A decade ago, the Royal Commission into Institutional Responses to Child Sexual Abuse heard from survivors the importance of trauma-informed responses.

A trauma-informed approach means prioritising a sense of safety for children who have experienced trauma, building trust and sharing control, to avoid retraumatisation.

This means explaining to children and their carers what is going to happen next, gaining their consent and giving them some control over the timing and pace of any interventions (such as being swabbed).

Children and families have different – sometimes traumatic – experiences of dealing with health services and police. So considering a child’s personal history and culture is important.

However there is still little research examining children and young people’s experience of crisis care.

My study involved seven girls, two boys and one non-binary child, aged between four and 16. In the days or weeks after their examination, I interviewed the child and the parent who attended hospital with them, both individually and together (in child-parent pairs).

The interviews uncovered four areas that were important to children and their parents.

1. Repeating their story but not feeling heard

After they first report their experience, children need to tell their story several times to various strangers.

This means sharing highly personal details while distressed to people who often don’t have the time to get to know them, their context, family, previous trauma history or culture.

Fiona* (16) found this aspect of the process “very, very, very stressful.”

Some said repeating their story felt like they had to convince professionals it was true.

Layla (14) commented:

I felt like I was the one in trouble.

2. Being treated with care matters

Several young participants discussed feeling “traumatised,” “intimidated” and “ashamed” during the examination itself.

Seven-year-old Sasha told us about the doctor who examined her:

She kept saying, ‘Lie still,’ and it was hard for me to just lie still. Then she just, when she did the examination […] I was crying on the bed, and it hurt me […]. And she just looked at me. Because she’s seen me crying and she just looked at me.

But when the doctor, or the clinician was caring – and took time to understand them and their individual needs – it helped ease some of the distress.

One parent, Kaye, felt the clinician “had this incredible demeanour and heart about her” and helped her child “understand what was going to happen.”

Other young people appreciated the clinician helped them with panic attacks and “made us feel relaxed.”

The youngest participant Ava (4) said she liked that she was given a teddy bear.

3. Unpleasant surroundings made the experience worse

Some participants described the space where the forensic medical examination took place as small and unwelcoming.

Dylan (16) felt it was “unsafe”, while Ava said it was “a bit scary”.

Examination spaces need to be kept forensically clean. In the hospital where these examinations took place, that meant there were no windows, pictures on the walls or soft furnishings.

Several young participants felt it showed what had happened to them was somehow shameful. As Felicity explained:

it was frightening. […] You’re just walking down a really long corridor, all these white […] ceilings and walls. And it was kind of just like a bit […] not welcoming, not nice and hidden away.

4. Parents need care too

Parents often felt sidelined or unheard before, during and after the examination.

Samira (a parent) said she didn’t feel like her concerns were understood:

I come from a different background, I don’t know what is happening and I don’t know what to ask. I’m not very trusting of police.

Children themselves worried about their parent. As Layla said:

it’s not just me that’s going through this, it’s my mum. […] I feel like she should be able to have that support too. None of it was offered to her.

One parent said they’d been “sent home without any support”. Another had a sense of being “just left there and wondering what to do”.

Responding to the whole child

The children and adults I interviewed made clear they wanted a holistic approach.

They wanted professionals (including doctors, clinicians and police) to not only pursue justice on their behalf, but also listen and respond to their physical, emotional and social needs and take into account their particular context and culture.

The response needs to make children and their families feel safer – not more scared.

It also needs to help them recover from the trauma, including counselling for both parents and children without long waitlists.

Existing services in the United States, Europe and the United Kingdom show an evidence-based, trauma-informed model is possible.

The National Sexual Assault, Family and Domestic Violence Counselling Line – 1800 RESPECT (1800 737 732) – is available 24 hours a day, seven days a week for any Australian who has experienced, or is at risk of, family and domestic violence and/or sexual assault.

*Names have been changed.

Caroline Whitehouse is employed by the Northern Centre Against Sexual Assault, which is affiliated with the peak body Sexual Assault Support Services Victoria (SASVic). She was previously employed by the Royal Children’s Hospital Melbourne, where this study took place. The Royal Children’s Hospital, along with LaTrobe University, gave ethics approval for the study.

– ref. ‘I felt like I was the one in trouble.’ Collecting evidence after sexual assault can be scary for children – and the system needs to improve – https://theconversation.com/i-felt-like-i-was-the-one-in-trouble-collecting-evidence-after-sexual-assault-can-be-scary-for-children-and-the-system-needs-to-improve-241902