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Comprehensive Medical Evaluation of Violence Against Children: Promoting Holistic Care

This medical standard encompasses the evaluation of physical, emotional, and social aspects of violence against children, including abuse and neglect. It includes a detailed examination, differential diagnosis, diagnostic work-up, and final treatment plan. The focus is on family-centered holistic care, two-generational assessment, mental health issues, developmental milestones, preventive care, and risk factors for violence.

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Comprehensive Medical Evaluation of Violence Against Children: Promoting Holistic Care

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  1. Medical evaluation of ALL violence against children PROMISE Brussels, 2107 RESMIYE ORAL, MD UNIVERSITY OF IOWA resmiye-oral@uiowa.edu

  2. Medical standard • Child’s medical history • Family medical history • Vital signs (… growth parameters) • Head to toe physical exam • Differential diagnosis • Diagnostic work-up • Medical • Forensic • Final diagnosis for treatment plan

  3. Physical, emotional, social, relational Emotional abuse Physical abuse Sexual abuse Neglect Well-being (Family centered)

  4. Medical standard • Child’s medical history and family medical history may help providers provide family centered holistic care to all family members • Two generational psychosocial, trauma/resilience assessment (family well-being evaluation) • Mental health problems in the family • Clues to emotional violence against child may be observed

  5. Medical standard • Child’s medical history and family medical history may help providers provide family centered holistic care to all family members • Developmental milestones • Missing preventive care (vaccines, lead level…) • Potential genetic disorders • Was ADHD diagnosis correctly established? • Risk factors for all forms of violence to child • Plan for referral for services for both generations

  6. Medical standard • Vitals: • Potential medical conditions (high BP, high HR…) • Growth charts • Weight: Nutritional neglect • Head circumference: Intracranial issues • Body length: Endocrine problems

  7. Medical standard • Head to toe physical exam • Genital exam • Beyond genitalia • Thorough skin exam (Oral-dental/breasts/ medial thighs/behind ears/neck/scalp) • Signs of medical illness or inflicted injuries may be caught

  8. Physical exam • To identify all treatable conditions child may have • Injuries, Sexually transmitted infections • Growth, developmental delay • Other medical conditions • To update missing preventive care • Reassurance of child and family…

  9. Medical exam in Barnahus • Injuries in covered areas of body • Oral/dental/breast/skin injuries may be related to sexual and non-sexual violence • Corroborating findings with forensic interview • Evidence collection can be done less traumatically during physical exam • Physical abuse, emotional abuse, dental neglect, nutritional neglect can be uncovered

  10. Kalamaki sunset

  11. Do they make sense together? Caretaker/Child HISTORY DEVELOPMENT/AGE MECHANISM, EXTENT ChildInjury

  12. Medical standard • Differential diagnosis • Medical/Accidental • Forensic • Diagnostic work-up • Medical (relevant labs) • Forensic (Evidence collection, STI screening)

  13. Medical standard • Final diagnosis for treatment plan: • Complete vaccines • High lead level: refer to hospital, DPH • Start iron for iron deficiency anemia • Refer to dentist (no dental care with decayed teeth) • Refer to developmental pediatrician

  14. Kalamaki, Turkey

  15. Medical standard • Final steps for forensic assessment: • Send forensic evidence kit material to forensic lab • Assault occurred within last 72 hours • No need for STIs : Hx credible, no physical contact, no ejaculation history, no genital discharge, abdominal pain… • Skeletal survey (infant <24 m/o, non-sexual physical abuse findings) • …

  16. REGIONAL ORGANIZATION Hospital Based CPT + Barnahus Local governments Local governments Forensic Medicine Inst. Forensic Medicine Inst. Schools Schools Dept. of Public Health Dept. of Public Health Prosecution Law enforcement Bars Child Protection Services Prosecution Law enforcement Bars Child Protection Services Child Death Review Teams Child Death Review Teams

  17. MANAGEMENT of CHILD ABUSE & NEGLECT • Hospital (Diagnostic evaluation) • Child Protective Services • Police Department/Gendarmerie • District Prosecutor • Courts • Hospital (Treatment) • Hospital (Diagnostic evaluation) • Child Protective Services • Police Department/Gendarmerie • District Prosecutor • Courts • Hospital (Treatment)

  18. Child Protection Program=Barnahus Severe Physical Abuse Criminal neglect, etc Acute Sexual Assault Sexual abuse Barnahus/Child Advocacy Center Sexual Abuse Child witnesses of crime Physical Abuse CAC/Barnahus Sexual Abuse Child witnesses of crime Physical Abuse Child Protection Program Severe Physical Abuse Criminal neglect, etc Acute Sexual Assault Sexual abuse Child Protection Program Severe Physical Abuse Criminal neglect, etc Acute Sexual Assault Sexual abuse

  19. Police forces Child protection services This is the Only we way We may serve all child victims of violence… Barnahus Hospital CPP prevention prosecution

  20. Thank you, Questions, comments… Resmiye-oral@uiowa.edu

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