General Considerations in the forensic medical examination of Deaf/Hard of Hearing Children

 

 

The Medical History

 

  • Follow their usual protocol and questions when gathering the medical history from a Deaf/HOH child, includes taking the medical history in the presence of the parent if that is the physician’s usual practice.

 

  • It is useful to be informed of any language or developmental delays, or any other disabilities, prior to conducting the assessment.

 

  • Try not to ask any questions already answered during the forensic interview. If an emergent medical evaluation preceding the forensic interview is needed, then the physician should gather the information necessary to appropriately diagnose and treat the child.

 

  • Tell the Deaf/HOH child that if they are not certain of the question or information that the physician is providing they should request clarification or repetition as many times as they need to, offer the option of writing down their answers or questions when other methods of communication seem inadequate.

 

  • It is important to identify a supportive person outside of the home that the child can reliably trust and share their concerns and fears with.

 

The Medical Examination

 

  • It is important to tell the child what will happen during the examination component; the child should be informed of each procedure just before it occurs as well. The medical professional should first explain what each bit of equipment is and what it does prior to the child disrobing.

 

  • The child should be allowed to have the support person of their choice in the room during the exam.

 

  • The examiner should continue to speak directly to the child rather than to the support person in explaining the medical procedures and results of the exam.

 

  • Every effort to maintain face-to-face contact with the child should be taken: raise the head of the exam table up so that the examiner can see the child during the exam and do not allow drapes, etc., to block this view.

 

  • Do not “talk shop” with other medical staff or personnel during the examination other than to request swabs or specific assistance with procedures.

 

  • Do not talk and perform a procedure at the same time; explain first, then perform the procedure.

 

  • Deaf/HOH children may opt to view colposcopic images on the computer if the examination room is equipped in such a manner.

 

  • Drawings of the various examination positions (supine, prone knee-chest, etc) will greatly facilitate the child’s understanding of, and cooperation with, positioning.

 

  • When the examination is done, have the child sit up, fully draped, and ensure that he or she understands the results of the examination prior to speaking with the parent.

 

Working with Parents

 

  • Many times communication between the parent and child is suboptimal- parents may not know what the child has said about the abuse, and may not know or understand whether abuse occurred.

 

  • It is especially important to ensure that parents understand most examinations of sexually abused children and adolescents are normal but this does not mean abuse did not occur, and that the medical diagnosis, as well as the investigation, relies primarily on the child’s history.

 

  • It is incumbent that the medical and Children’s Advocacy Center staff help the parents understand the importance of believing and supporting in the recovery of their child.

 

 

Cassady, C., Kellogg, N., MacDonald, M.,Mounty, J., & Northrop, K. (n.d.) Guidelines on Children’s Advocacy Center Services for Children who are Deaf/Hard of Hearing. Hartford: CT.             http://www.nationalcac.org/professionals/images/stories/pdfs/cc%20standard%20chandler%20hearing%20i    mpaired.pdf