Pediatric Sexual Assault Program: 10 Years in Review

Abstract

Category/Date Practice Innovation Poster presented at Posters on The Move , at NAPNAP's 40th National Conference on Pediatric Health Care, March 9, 2019, New Orleans, LA. Background The Children's Hospital of Philadelphia (CHOP) launched a pediatric focused program to care for the critical and highly unique needs of children who are victims of acute sexual assault in 2009. Before this launch, pediatric sexual assault victims were transferred to an adult emergency department for acute care. Providers, patients, and their families recognized that pediatric patients have unique developmental needs that would best be served at a pediatric focused facility. Aims of Service Change To address this concern we implemented a developmentally appropriate, pediatric-focused Sexual Assault Response Team (SART) to provide the recommended and most up-to-date care available for pediatric patients and their families. The ultimate objective of developing a pediatric SART was to minimize trauma to the young sexual assault victims. Details of Innovation The initial phase included building a sexual assault pathway. A multidisciplinary team was identified for 24/7 care for victims. Integrative approaches to training were developed using mannequin simulation, didactic instructional videos, annual conferences, and peer-to-peer educational methods. These trainings were created, modified, and then reconfigured to foster the most sustainable care to these complex patients. A database was built to capture trends and treatments. Monthly quality improvement and leadership sessions were held to focus on patient care and outlining a model for replication at other pediatric-serving institutions. Outcome Since its inception 10 years ago, our SART has treated nearly 1000 victims (83.6% females, 16.4% males) of acute sexual assault. The SART has provided care for children as young as 6 months of age. The evolution of the program has created a system of care that can be catered to the unique individual needs of each victim. The creation of the acute pediatric sexual assault pathway has been one of the paramount factors in our success. Educational needs were addressed via ongoing trainings. The training process has established a large cohort of peer trainers equipped with the knowledge, tools, and curriculum to sustain a core training group that is now integrated hospital-wide. Our training process remains paired with hospital-based quality improvement, where stakeholder opinion, outcome data analysis, and expert review support the inclusion of new trends and treatment recommendations as they arise. Evaluation of Change Our lessons learned derive from our population, trends and treatment, and unique patient situations. We continually review our data to outline necessary changes and tailor our approach. We have identified that 95% of patients are females younger than 16 years old, brought to the ED within 24 hours of the incident. 30.1% of all patients have reported/identified bodily injuries. Alleged perpetrators (96.1% males, 3.2% female and 0.7% unknown) include but are not limited to extended family members, stranger abductors, and acquaintances. Areas in which we strive to increase optimization include a standardized approach to the physical examination, care coordination, and forensic evidence collection. Data reveals both seasoned and newly recruited team members have improved the overall patient outcome with consistent educational efforts linked to quality improvement monitoring, data analysis, expert review of guidelines, practices and individual care episodes.