Child Sexual Abuse : Parent and Child Interview, Medical Examination

by Child Welfare Information Gateway

(Page 2 of 4)

The Child Interview

There are several issues related to the child interview that should be determined before it takes place. These include where it should occur, who should be present, how information from the interview will be recorded, and how many interviews are needed.

The interview should occur in a location the child perceives as a "safe place." In most instances, this will not be the child's home, but it may be the child's school, a therapist's office, a child interview room at the CPS office or police station, or a Children's Advocacy Center. Originating in Huntsville, Alabama, this center is a child-oriented facility developed specifically for interviewing and providing services to sexually abused children. It represents a successful strategy for addressing the often fragmented and potentially alienating approach to service delivery that characterizes how many communities handle child sexual abuse. This model has been replicated in other communities. When used for interviewing children, usually specialized facilities are equipped with one-way mirrors, so that the interview can be observed or videotaped.

As mentioned above, investigations may be conducted conjointly by CPS and law enforcement. In some communities, CPS is responsible for the child interview, and law enforcement interviews the alleged offender. In other communities, both are present at the child interview, although only one usually conducts the interview. Alternatively, one of the investigators (and relevant others, such as a mental health expert or an assistant prosecutor) may be behind the one-way mirror. Having more than one person present during the child interview may eliminate the need for multiple interviews.

Some record should be made of information gathered during the child interview. This may be a videotape, an audiotape, or notes. Notes are more easily taken by someone who is not interviewing the child. Each of these methods of data gathering has its strengths and weaknesses.

The number of interview sessions usually depends on who is conducting the investigation. In the majority of cases, CPS conducts one interview. If no confirming evidence emerges and there is no other supporting evidence, the CPS worker will usually deny the case after a single interview. Similarly, hospital-based programs that conduct investigations for law enforcement and CPS conduct a medical exam and a single interview, unless the interview is inconclusive or there are confirming medical findings and no disclosure. In contrast, mental health experts assessing children at the request of mandated agencies or the courts often conduct several interviews. In the latter instances, the child is usually in a protective environment.

It is usually optimal to interview the child before interviewing the parents. The rationale for this order is that, in most cases, the child's statements and behavior are the primary means for determining whether sexual abuse occurred. Consequently, having some indication of the likelihood of sexual abuse and, if likely, knowing its specifics may be useful in later interviews with the nonoffending parent and alleged offender.

As part of the investigation, it is important that all children, both males and females in the target victim's family or abusive circumstance (e.g., day care center) are interviewed. There are two reasons for this. First, offenders generally have multiple victims, not a single one. Second, even if other children are not victims, they may be witnesses.

A question of strategy is whether, in situations in which there are potentially multiple victims, children should be interviewed separately or as a group. Disclosures may be inhibited or facilitated by either practice. For example, a child may be helped to describe sexual abuse by the presence of an older, more forthcoming sibling. Alternatively, the presence of siblings may reinforce the family prohibition against telling secrets. An additional consideration is that a more sophisticated understanding of the abuse and its significance may be obtained by observing the interaction among children. Because of real or apparent issues regarding contagion, children should initially be interviewed separately, with conjoint interviews occurring later.

The Medical Examination

Views regarding the advisability of a medical examination have changed considerably in recent years, largely because of a perspective offered by Sgroi. Professionals had many reservations about the appropriateness of a medical exam for sexually abused children because of its potential to retraumatize the child and because the probability of supportive medical findings was generally remote. However, Sgroi advocated the use of a medical exam as a context to assure the child and her/his caretakers that she/he was undamaged and intact. Thus, negative findings become positive.

Today, most professionals working in sexual abuse adhere to Sgroi's viewpoint. Thus, the child should receive a medical examination at some point during the investigation. Generally, physicians only see the necessity of an immediate exam when the abuse is quite recent and/or there is concern about injury or disease. Otherwise the exam can be postponed for a few hours until there is an experienced health care professional available with sufficient time available to conduct the genital exam and necessary tests in the context of a general physical exam.

The Interview With the Nonoffending Parent

The investigative or assessment interview with the mother has several purposes:

• to gather additional information about the likelihood of the sexual abuse;
• to determine whether the mother is protective and supportive of the victim;
• in some instances, to ascertain if the mother has had a role in prompting the child to make or recant an allegation; and
• to understand the causes or dynamics leading to the sexual abuse.

Mothers may provide information that either supports or refutes the child's allegation. However, as noted earlier, the child interview is the primary context for gathering information to determine the likelihood of the sexual abuse. The typical initial reaction of mothers confronted with an allegation of sexual abuse is denial, both psychological and actual.

It is important for the investigator to evaluate carefully a mother's protests that "this couldn't have happened because the child is never alone with the alleged offender," that "the child has a long history of telling lies," or that "the child is making this allegation because she is jealous of the new baby" in light of the mother's propensity to disbelieve or deny. Nevertheless, there can be circumstances in which mothers provide information that rules out sexual abuse.

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