Medical assessment and legal outcome in child sexual abuse

Objective: To examine the relationship of behavioral symptoms, interview di sclosures, and physical examination findings with changing legal outcomes i n child sexual abuse. Design: Retrospective case series. Setting: Hospital- and community-based multidisciplinary child abuse evalua tion teams in the same county in 2 periods. Patients: Children ages 0 to II years referred for evaluation of sexual abu se. Main Outcome Measures: Substantiation by child protective services, issuanc e of a warrant by law enforcement authorities, and criminal penalties were compared with reported changes in behavior, disclosure by the child, and ph ysical evidence on examination. Results: Among 497 children evaluated in 1991-1992 and 1995-1996, those wit h a positive examination finding were 2.5 times more likely to result in a criminal prosecution with a finding of perpetrator guilt (P < .001). Simila r rates of disclosure, positive examination findings, child protective serv ices substantiation, and warrant issuance were noted in the 2 periods. Decr easing rates of guilt determination and increasing criminal penalties were identified in 1995-1996 (P < .002). Disclosure of child sexual abuse during medical assessment was significantly associated with a positive physical e xamination finding, child protective services substantiation, and issuance of a warrant, but not a finding of guilt or criminal penalty. Conclusions: Medical assessment plays an important role in the overall comm unity response to child sexual abuse. While behavioral symptoms and disclos ure are important in medical treatment and child protective services invest igation, positive physical findings are associated with a finding of guilt. There is a trend toward less finding of guilt and more years of criminal p enalty that is not explained by case characteristics.