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SHIPS Medical and Mental Health Programs

SHIPS Medical and Mental Health Programs

SHIPS (Support of Health-Involved Professionals in Child Safety Centers) - MEDICAL

INTRODUCTION

Skilled medical evaluations of children suspected of having been sexually abused may have the following benefits:

  • Diagnosis and treatment of medical conditions resulting from sexual abuse, including identification and documentation of evidence of abuse and collection of forensic evidence;
  • Differentiation of variants of normal anatomy commonly mistaken for injury, and diagnosis and treatment of other medical problems which may mimic abuse;
  • Reassurance of the child and family when the exam is normal;
  • Psychosocial support, assessment of  safety and referral for counseling; and
  • Provision of expert witness testimony.

However, a poorly performed examination can result in added stress to the child, loss of evidence, and failure to diagnose a sexually transmitted disease.  An incorrectly interpreted exam can result in failure to protect a child, unnecessary disruption of a family, and false accusations of an alleged perpetrator.

The SHIPS Medical Network, an educational network of sexual abuse examiners, is a structured educational vehicle created at the request of examiners in Arkansas’ Child Safety Centers (CSCs, also called Children’s Advocacy Centers), although not restricted to them.  It functions in collaboration with the Arkansas Commission on Child Abuse, Rape and Domestic Violence and the Children’s Advocacy Centers of Arkansas.


GOALS

A goal of the SHIPS Medical Network is to maintain and enhance the quality and accuracy of examinations and their interpretations by a sharing of information with examiners who have demonstrated a commitment to the field.  The Network will also foster a sense of collegiality and peer support among the examiners.

Membership in the Network is not a certification of skill in the medical evaluation of children suspected of having been sexually abused.  It is a program of demonstrable systematic continuing education and peer support.  Competency in the field may be achieved and maintained by other means.

CRITERIA FOR MEMBERSHIP

Enrollees must be licensed physicians, registered nurses, or advanced practice nurses.  Registered nurses must be able to document child sexual abuse/assault specific didactic and clinical training and have the clinical support of a professional with prescriptive authority.  Thus, to enroll in the SHIPS Medical Network, registered nurses must have all of the following:

  • Successful completion of the didactic and clinical components of a Sexual Assault Nurse Examiner (Adult/Adolescent) Training (A-SANE) in accordance with International Association of Forensic Nurse Training Guidelines;
  • Successful completion of didactic and clinical components of a Pediatric Forensic Nurse Training (P-SANE) in accordance with International Association of Forensic Nurse Training Guidelines; and
  • Supervision by a local physician or advanced practice nurse who is licensed and board eligible or certified in pediatrics, family practice, gynecology, or emergency medicine; participates in yearly CME on child abuse issues; peer reviews any exam findings indicating child sexual abuse; and is a tertiary examiner or participates in peer review with one.

Members must have performed genital exams of 35 to 50 females less than age 18 per year, whether or not they are suspected victims of sexual abuse, or have a cumulative clinical experience including 150 such cases.  They must be able to perform all of the following:

  • Obtain a screening medical history to determine whether an examination needs to be performed immediately, or if it can be scheduled at a later time;
  • Obtain a complete medical history, including past medical history, current symptoms and recent treatment, if any;
  • Understand the concept of differential diagnosis, and the signs and symptoms which can be caused by conditions other than abuse;
  • Test for sexually transmitted diseases and provide appropriate initial management, address potential pregnancy issues in post-pubertal female patients, collect forensic evidence as appropriate, and provide treatment when indicated;
  • Employ diagnostic quality photo documentation and release photographs or videotapes of examinations  when ordered by the court for review by other professionals designated by officers of the court, whether prosecution or defense;
  • Refer either the patient or photodocumentation images to a more  experienced examiner when needed for confirmation that a significant finding may be present, and arrange for other appropriate referrals (including mental health) and follow-up tests for sexually transmitted diseases and pregnancy;
  • Understand and accept responsibility for providing court testimony if needed; and
  • Demonstrate ongoing continuing medical education relevant to child sexual abuse issues and remain current on the medical literature through participation in the SHIPS Medical Network.

Enrollees do not have to be members of a Child Safety Center.  However, they must have the same telemedicine capability as those centers or be able to participate with an established center that is a member of the Children’s Advocacy Centers of Arkansas and has that capability.


THE PROGRAMS

The SHIPS Medical Network will offer the following to its enrollees.

  • Quarterly Reviews will provide educational offerings by teleconference that examine cases with specific educational merit or reflect controversy in interpretation of exam findings or management.
    • Attendees will participate in the review, analysis and discussion of de-identified cases.  The site of each enrollee will submit at least one case for review and discussion at each quarterly review.
    • The Network administrator will record the submitters and brief non-identifiable information regarding the submitted cases.
    • If no cases have been submitted by an enrollee’s site for two consecutive quarters, the Network administrator will notify the site.  If no cases are submitted for the third Quarterly Review and no extension is requested and granted by the Administrator, the enrollees of that site will be removed from the Network.
    • The network administrators will provide continuing medical education credits for nurses who attend and respond to a brief post-conference evaluation.
  • Medical staff of the Center for Children at Risk will provide peer review of cases on an individual basis as needed for members of the Network.  They will assist with interpretations of exam findings and management, court testimony and administrative issues involving health care. 
  • A quarterly newsletter, the SHIPS’ Log, will provide reviews of a clinical problems and relevant published articles, physical exam “unknowns”, quizzes with answers, useful information and spotlights on CSCs or examiners.  Nurses who complete a brief post-log test will receive CME credits.
  • At the request of enrollees, additional conferences will be provided, either by teleconference or at Arkansas Children’s Hospital.  The cost of this service for providers in Arkansas’ Children’s Advocacy Centers will be covered by the SHIPS program.
  • Clinical preceptorships in the UAMS Arkansas Children’s house will be available if requested.

SUMMARY

The SHIPS Medical Network is a structured educational vehicle for medical examiners of children suspected of having been sexually abused.  Through teleconferences, sharing of clinical materials, print material and other means, high quality medical evaluations will be achieved and maintained.  The network will also foster a sense of collegiality and mutual support among Arknasas’ medical examiners working in this difficult and stressful field.

SHIPS - MENTAL HEALTH

Studies have documented the long-term consequences of child abuse.  More than half of the children abused in Arkansas have the potential to develop significant problems as adults.  These include suicide, high risk sexual behaviors, criminal activities, and violence.  The consequences can be devastating to the individual, their families, and their communities long after the abuse has ceased.

The goals of the SHIPS-Mental Health Program are to provide educational support for (1) mental health professionals who are in cooperative agreements with Arkansas’ Child Safety Centers (CSCs) and (2) family advocates in those centers.  Specific activities will include the following:

  • Training and support of mental health screening of all children presenting to CSCs;
  • Continuing education in trauma-focused cognitive-behavioral therapy, consultation, supervision, and technical assistance of mental health professionals in cooperative agreements with CSCs;
  •  Development of care pathways in the CSCs;
  • Ongoing supervision and technical assistance for mental health professionals;
  • Development, dissemination, and linkage to resources for CSC professionals working with abused children;
  • Partial funding of CSC therapists by RFQs administered through the  Arkansas Commission on Child Abuse, Rape and Domestic Violence;
  • Participation with the UAMS Psychiatry Research Center in the BEST Program for development of a mental health screening tool, standardized assessment protocols, pre- and post-evaluation process, and a database for follow-up of child abuse treatment.

The result will be an increase in evidence-based mental health services available for Arkansas’ abused children and their families.

 
Center for Children at Risk
University of Arkansas for Medical Sciences
Department of Pediatrics
Arkansas Children's Hospital
1 Children’s Way, Slot 512-24A
Little Rock, AR  72202
(501) 364-1013

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