TRIAGE AND REFERRALS FOR CHILD SEXUAL ABUSE MEDICAL EXAMINATIONS - WHICH CHILDREN ARE LIKELY TO HAVE POSITIVE MEDICAL FINDINGS

HIBBARD (1998) HAS presented a thoughtful and useful approach to resea rch on issues of medical triage and referral in suspected sexual abuse cases, using as a model the Medical Outcomes Study assessing structur e, process and outcomes of care (Tarlov et al., 1989), With this appro ach, one can systematically look at appropriateness, quality, timing, and cost of care, all of which are relevant to triage and referral iss ues in child sexual abuse cases. This paper will focus on one of the q uestions framed by Hibbard, that is, ''How do we approach the question of which children are likely to have positive medical findings?'' Whi le this question does not constitute the entire question ''Which child ren should be examined, when and by whom?,'' it is a very important tr iage consideration. The number of children presenting to the sociolega l system with suspected sexual abuse far exceeds the capacities of reg ional medical assessment centers (Kerns, Terman, & Larson, 1994), Assu ming that positive medical findings will be most accurately diagnosed, treated, documented and, when necessary, entered into court testimony by professionals working in centers of excellence, it would be approp riate to selectively refer children who have the highest probability o f positive findings to these centers. To do so, research is needed on the identification of suspected child sexual abuse victims who are at high risk for positive clinical findings. This paper will review the f indings of a retrospective case control study done in Santa Clara Coun ty, California, emphasizing both findings and shortcomings, and will r ecommend a methodologic approach to future research on the prediction of positive medical findings in suspected victims.