What is an Evaluation?

A clinical sexual abuse evaluation is a non-forensic, structured, trauma-informed assessment of a child’s functioning, behaviors, statements, and other context to determine whether their presentation is consistent with possible sexual abuse or other explanations. Evaluations will provide clinical recommendations that are safety, risk, and treatment focused.

A sexual abuse evaluation might be beneficial when there are concerns about a child’s safety, experiences, or well-being; and more clarity is needed. You might consider an evaluation if a child has made a disclosure, you notice behavioral or mood changes, there is conflicting perspectives between caregiving adults, previous investigations were inconclusive, there is concern about outside influence, or a child has experienced something distressing, even if abuse is not confirmed.

A quality clinical sexual abuse evaluation is structured, developmentally informed, and based on the child’s readiness. It is not a one-time interview but rather an undetermined number of interview sessions. Number of sessions with the child is decided on a case by case basis. A comprehensive evaluation will also include structured caregiver interviews that focus on history, child functioning, and relevant context; collateral interviews with relevant providers and review of relevant records, utilization of diagnostic measures determined on a case by case basis, assessment of emotional, behavioral, and trauma-related functioning, and consideration of alternate explanations for a child’s presentation. The process is intentionally flexible. The evaluator will not ask leading questions, including in the form of follow up, and should not verbally challenge a narrative that a child provides. Verbally challenging a child’s narrative is equivalent to asking leading questions.

Forensic interviews are an investigative tool conducted by investigative agencies. They are designed to gather factual information for legal purposes. They typically occur in one session and follow a highly standardized protocol. Clinical evaluations are conducted for treatment and diagnostic clarity, and safety planning. The main goal is to understand the child’s overall functioning, experiences, and needs. Clinical evaluations do not replace forensic evaluations and do not determine or conclude guilt or innocence.

Families can expect contact with collaterals, records, and caregivers, individual sessions with the child using developmentally appropriate methods, gradual exploration of relevant themes based on the child’s readiness, limited sharing of session details during the process to protect the integrity of the evaluation, and communication about general progress and next steps. At the conclusion a written report will be provided with clear recommendations related to safety, supports, and treatment.

Unlike older children, kids age 7 and under require a modified process designed to reduce pressure and support accurate understanding of the child’s developmental level and communication style. Clinicians may assess play themes and symbolic expression, language and body based communication/ behaviors, a child’s understanding of concepts such as real versus pretend, safe versus unsafe, secrets versus surprises, and tracking of consistent patterns over time. For young children, caregiver and collateral reporting holds significant weight. Young children typically do not provide linear narratives, and a child’s experience may emerge in small pieces over time, rather than in a single clear statement.

All evaluators and therapists at Heal RI practice mandated reporting in accordance with the RI law. Within mandated reporting circumstances, clinicians forego the expectation to obtain releases first or notify other adults and caregivers of a call made to Child Protective Services, should the clinician deem this necessary.

To ensure evaluations produce optimal results, it is important to minimize big changes for children being evaluated during the evaluation process, to the best of our ability. This could mean changes in medications, living situations, engagement in activities, changes in school setting, etc. The evaluation process is a very temporary one and limiting big changes helps with the diagnostic rule-out process.