Improving Accessibility and Quality of Child Abuse Medical Evaluations

Continuous Quality Improvement and Education for Child Abuse Medical Providers

Medical evaluations of child sexual abuse are acknowledged in the child maltreatment field as a valuable part of an investigation as they improve the likelihood of timely medical care to a child victim and can provide information to support legal decisions. (Adams et al, 2007) The well being of child sexual abuse victims depends on high quality, consistent medical evaluation techniques and competencies. Provider participation in continuous education, peer review an quality improvement activities have recently been emphasized in the field. The NCA Accreditation Standards recognize that,“A medical evaluation holds an important place in the multidisciplinary assessment of child abuse. An accurate history is essential in making the medical diagnosis and determining appropriate treatment of child abuse.”

Because such activities can be costly, and accessibility limited in rural geographic areas, the Midwest Regional Medical Academy was created to bridge this gap.







Midwest Regional Medical Academy programming and services are guided by nationally known experts in the field of child abuse.

Suzanne Starling, MD - Co-Medical Director: Dr. Starling, who is medical director of Children’s Hospital of The King’s Daughters regional child abuse program in Norfolk Virginia, has been recognized for her outstanding contributions to the field of child maltreatment by APSAC.  Dr. Starling is a professor of pediatrics at Eastern Virginia Medical School and serves as chief of the school’s division of Child Abuse Pediatrics and director of the Child Abuse Pediatrics Fellowship program.  Dr. Starling served as the second chair of the American Board of Pediatrics sub-board on Child Abuse Pediatrics and also is immediate past chair the Executive Committee of the Section on Child Abuse of the American Academy of Pediatrics.  Dr. Starling is a charter member of the Ray E. Helfer Society, an honorary society for physician specialists in child abuse.  She has spent her career collaborating with investigators and attorneys to improve the investigation and prosecution of child abuse.  She regularly provides expert medical testimony in child abuse cases.  Dr. Starling lectures internationally for medical, investigative, and legal audiences, and has published more than 30 journal articles and book chapters in the field of child abuse.

Lori Frasier, MD - Co-Medical Director: Dr. Frasier attended the University of Utah School of Medicine. She completed a pediatric residency and child abuse fellowship at the University of Washington, Seattle Children's Hospital. She has served on the faculties of the University of Iowa and the University of Missouri-Columbia. At Missouri she was head of the Child Protection Program and Director of the Division of General Pediatrics. She is currently a professor (clinical) in the Department of Pediatrics, the Division of Child Protection and Family Health. She is the Program Director for the newly accredited Fellowship in Child Abuse Pediatrics. Dr. Frasier's clinical interests are in the evaluation of child abue and neglect, and has a special clinical interest in medical conditions which mimic child abuse. She has lectured extensively locally, nationally, and internationally. Dr. Frasier has been especially involved in TeleHealth issues surrounding accuracy of diagnosis of both physical and sexual abuse. She is the director of the state wide program funded by the Attorney General's office that provides medical supervision of medical providers in Children's Justice Centers throughout Utah. She is well published in areas of Child Sexual abuse and Abusive Head trauma and is considered a leading expert in the US and Internationally in Child Abuse issues.

Updated Guidelines for the Medical Assessment and Care of Children Who May Have Been Sexually Abused The Midwest Regional CAC is honored to have been involved in the preparation and publication of this important manuscript in the Journal of Pediatric and Adolescent Gynecology. From the abstract: The medical evaluation is an important part of the clinical and legal process when child sexual abuse is suspected. Practitioners who examine children need to be up to date on current recommendations regarding when, how, and by whom these evaluations should be conducted, as well as how the medical findings should be interpreted. A previously published article on guidelines for medical care for sexually abused children has been widely used by physicians, nurses, and nurse practitioners to inform practice in this field. Since 2007, when the paper was published, new research has suggested changes in some of the guidelines and in the table that lists medical and laboratory findings in children evaluated for suspected sexual abuse and suggests how these findings should be interpreted with respect to sexual abuse.

The Evaluation of Suspected Child Physical Abuse This article in American Academy of Pediatrics outlines the important role of pediatricians in preventing, identifying, and treating child physical abuse. From the abstract: Child physical abuse is an important cause of pediatric morbidity and mortality and is associated with major physical and mental health problems that can extend into adulthood. Pediatricians are in a unique position to identify and prevent child abuse, and this clinical report provides guidance to the practitioner regarding indicators and evaluation of suspected physical abuse of children. The role of the physician may include identifying abused children with suspicious injuries who present for care, reporting suspected abuse to the child protection agency for investigation, supporting families who are affected by child abuse, coordinating with other professionals and community agencies to provide immediate and long-term treatment to victimized children, providing court testimony when necessary, providing preventive care and anticipatory guidance in the office, and advocating for policies and programs that support families and protect vulnerable children.

If you have questions or could use additional information, please contact Kim Martinez, Program Manager, Peer Review & Medical Academy at or 612.759.9344.

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