Medical assessment for child sexual abuse: a post-code lottery?

To describe the number of children and young people in New Zealand who receive a medical assessment for sexual abuse, the proportion of those where there is concern about sexual abuse who receive such assessments and the way in which assessment services are structured.

Medical assessments for child and adolescent sexual abuse over 12 months were counted by direct communication with health providers throughout New Zealand, and compared with the number of cases substantiated by statutory child protective services, the number of claims for counselling for mental injury from sexual abuse and the regional population. All doctors providing medical assessments were surveyed as to how this was organised by region.

There were 804 medical assessments. Child protective services regarded 1207 cases as substantiated, and 1434 claims for mental injury were lodged. There was marked regional variation. In a matched sample, only 38% of cases of substantiated sexual abuse were seen for a medical assessment. A doctor with expertise in the assessment of sexual abuse was available in most areas, but service structure varied widely. The availability of nurse or social work support was poor. The proportion of children and adolescents receiving a medical assessment, and the quality of service structure, was directly related to regional population.

Health assessments for alleged child and adolescent sexual abuse are relatively infrequent, nationally inconsistent and often poorly supported by local health systems. There is also marked but apparently unrelated regional variation in statutory child protection practice.