Contents lists available at ScienceDirect Children and Youth Services Review journal homepage: www.elsevier.com/locate/childyouth Parents' perceptions of the value of sexual abuse medical evaluations of their children Karen B. Worley a , Janice K. Church a, ⁎ , Toss Worthington a , Christopher J. Swearingen a,b , Jerry G. Jones a a Department of Pediatrics, Arkansas Children's Hospital, College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72205, United States b Private Company, San Diego, CA, United States ABSTRACT Most sexual abuse medical examinations reveal no abnormalities. This study's objective was to assess the value of a “certification of normalcy” for parents whose children had/didn't have abuse evaluations. Two questionnaires were developed for administration to guardians of sexually abused children enrolling in a specialized outpatient mental health program. On the questionnaire given to 42 parents whose children had received medical eva- luations, caregivers commonly endorsed prior concerns about injuries, infections, genital penetration, and proof of sexual assault. 74% rated the examinations as helpful to them and 41% of caregivers believed knowledge of the results was helpful for their children age seven or older. 76% of guardians indicated they would obtain examinations if events were recreated. The questionnaire given to 47 parents of non-examined children revealed less concern about injury, infection and signs of penetration. However, 28% of these caregivers indicated they would obtain examinations if events were recreated. Study results support a belief that sexual abuse medical evaluations have value to many parents. 1. Introduction The medical evaluations of children and adolescents who have been sexually abused have been accorded four purposes: screening for in- juries and infection, identification of physical evidence of the sexual abuse, initiation of medical treatment, and reassurance of victims and parents based upon the examination findings (Britton, 1998; Finkel, 2005; Walsh et al., 2007). Most sexual abuse examinations reveal an absence of physical evidence of the abuse (Adams et al., 1994). Ex- aminers usually can provide reassurance of wellness to the children and parents, a “certification of physical normality” (Finkel, 2005; Jones & Farst, 2011). Parental and child anxiety about the sexual abuse medical exam may lead parents and professionals to avoid referring children for this service. While children and parents may indeed experience some an- xiety regarding the sexual abuse exam, most do not express clinically significant anxiety (Gully et al., 2000; Rheingold et al., 2013). Children with more severe abuse, cognitive difficulties, a chronic medical and/or prior mental health diagnosis, who have an ano-genital exam requiring anal or genital cultures, and who lack private/public medical insurance may benefit from more exam preparation (Gully et al., 2000; Horner et al., 2009). The results of these studies suggest the importance of providing a quality exam with careful preparation of parents and children in reducing their worry and anxiety. In one study, parents found the medical examination significantly less stressful than they had anticipated. The authors concluded that medical exams for child sexual abuse do not further traumatize the child and are in fact reassuring to children and parents (Marks et al., 2009). Nevertheless, the specific value of sexual abuse medical evaluations to those parents whose children had them appears to be largely un- reported, and the literature has been silent on possible parental health and physical injury concerns. Similarly, parents' perceptions of the value of sexual abuse medical examinations to their children are also unreported. What is known, however, is that psychological outcomes for sexual abuse victims are significantly affected by a family's response to the abuse (Deblinger et al., 1999). The purpose of this study is to assess parents' perceptions of the value of sexual abuse medical eva- luations when entering a sexual abuse mental health family treatment program. The study began by giving a survey to patients to determine if families needed referrals for medical examinations and evolved into a https://doi.org/10.1016/j.childyouth.2018.04.005 Received 22 November 2017; Received in revised form 30 March 2018; Accepted 2 April 2018 ⁎ Corresponding author. E-mail address: churchjanicek@uams.edu (J.K. Church). Abbreviations: UAMS, University of Arkansas for Medical Sciences; ACH, Arkansas Children's Hospital; REDCap, Research Electronic Data Capture Children and Youth Services Review 88 (2018) 486–489 Available online 04 April 2018 0190-7409/ © 2018 Elsevier Ltd. All rights reserved. T