This document is designed to provide guidance regarding health and medical services for children who have been sexually abused, or when there is a concern that sexual abuse has occurred. It provides information regarding access to Pediatric SANE services and addresses the most frequently asked questions about these services. This document is not intended to be an all inclusive document, but rather one that reflects the most commonly asked questions about the Pedi SANE Program and medical/health services related to sexual abuse.
Medical providers and school nurses may access Pediatric SANEs for any medical/health consultation related to sexual abuse for any child. Pediatric SANEs may also be utilized as resources for families who have health concerns related to sexual abuse/assault. Please note that family access to Pedi SANEs occurs through clinician to clinician referral. Families should not be directly referred to the Pedi SANE.
What services do Pedi SANEs provide to medical providers and school nurses?
Pediatric SANEs are directly available to medical providers and school nurses for:
- Consultation regarding health and medical concerns related to disclosures or concerns for sexual abuse;
- Consultation regarding behaviors that may be concerning for sexual abuse (sexualized behaviors)
- Case management around medical/health issues related to sexual abuse
- Access to specialized sexual abuse examinations for children/families in their care
- Educational presentations related to the health/medical needs of sexually abused children
Where can I access Pediatric SANE Services?
Pediatric SANE services can be accessed at different locations across Massachusetts. Currently, six of the state's eleven Children's Advocacy Centers have Advanced Practice Pediatric SANE 2s (Nurse Practitioners or Clinical Nurse Specialists) who provide on-site services on a Monday-Friday, 9AM - 5PM basis (see list below for PT/FT availability). Pediatric SANE services are available to ALL medical providers and school nurses statewide regardless of county.
Contact Information for Pediatric SANE Services in Children's Advocacy Centers (CACs)
- Berkshire County Kid's Place - Pittsfield, MA
- Children's Advocacy Center of Bristol County, Fall River, MA
- Essex Children's Advocacy Center - Salem (North Shore Children's Hospital) and Lawrence (Lawrence General Hospital)
- Norfolk Advocates for Children, Foxboro, MA
781-830-4800 ext. 310
- Conway Children's Advocacy Center of Plymouth County - Brockton, MA
- Children's Advocacy Center of Suffolk County, Boston, MA
Contact Information for Pediatric SANE Services in Emergency Departments (EDs)
Lawrence General Hospital provides a 24/7 Pediatric SANE response, including forensic evidence collection, for children < 12 with a disclosure of sexual abuse that occurred within a 72 hours period, and for children 12-17 years with a disclosure of abuse that occurred within a 120 hour period
- Lawrence General Hospital Emergency Department
(978) 683-4000 ext 2500
What services do Pediatric SANEs provide to children and families?
When a clinician to clinician referral is made and services are deemed appropriate, Pediatric SANEs provide a variety of health and medical services to children and families. Children and their guardians often have many questions and concerns about the impact of sexual abuse on their current health and future well being. Children and families have concerns about possible injuries and the risk of sexually transmitted infections. Pediatric SANEs are available to talk or meet with families, and as needed to conduct examinations and testing for sexually transmitted infections.
Most pediatricians, medical providers and school nurses do not have a comfort level or expertise in this specialized area of child sexual abuse. Pedi SANEs can provide this level of expertise directly to the child/guardian. With the guardian's permission, the Pedi SANE will work closely with the child's medical provider or school nurse to ensure that care is coordinated and comprehensive.
Services are tailored to meet the individual needs of the child/family and may include:
- Phone consultation or face-to-face consultation with the child's guardian/child about medical/health concerns related to sexual abuse
- A head-to-toe physical exam focused to documentation of injuries or symptoms of infection related to sexual/physical abuse
- A non-invasive Medscope exam of the child's external genitals to assess for new or old injuries related to sexual abuse. NO internal/speculum exam is done (unless child is a physically mature adolescent and history indicated the need for such exam).
- Forensic evidence collection using the Massachusetts Pediatric Sexual Assault Evidence Collection Kit (MPSAECK) for children < 12 years of age when sexual abuse occurs within a 72 hour period and a child is not currently in an emergency department.
- Testing for Sexually Transmitted Infections (STIs) such as gonorrhea, Chlamydia, HIV
- Follow-up examinations to document healing of injuries or resolution of medical concerns
- Health/medical case management related to sexual abuse/assault
What happens during a Pediatric SANE examination?
The exam is very much like exams that all children receive from their medical provider. The Pedi SANE exam proceeds from head-to-toe carefully looking for signs of injuries on the child's body. Extra attention is given to examination of the child's genitalia. Girls are examined in a frog-leg position. In this position, the child's genitalia will be fully visualized in a manner that is not painful or invasive. A Medscope (video-documentation system) is used to externally light and magnify the child's genitalia, and allows for digital images of the exam to be obtained and stored. If sexual abuse occurred within a 72 hours period, forensic evidence collection using the MA Pediatric Sexual Assault Evidence Collection Kit may also be completed.
Are children sedated for Pediatric SANE exams?
No, children are never sedated because these examinations are non-invasive. An exam done by a Pedi SANE is not painful or traumatic. In the rare occasion that the child is not able to cooperate with an exam, the exam is usually rescheduled for a later time. Most children find the examinations reassuring and positive experiences.
If a child is not cooperative during an exam, is another examination always rescheduled?
If a child is uncooperative, the importance of repeating the exam would be based on the child's clinical presentation and the level of concern for injury based on the allegations. There are times when it is determined that it is probably not in the best interest of the child to attempt another exam. Those decisions are made in conjunction with the child's parent.
What is the Massachusetts Pediatric Sexual Assault Evidence Collection Kit (MPSAECK)?
The MPSAECK is a forensic evidence collection kit that was specially designed for emergency department clinicians to use for children < 12 years of age. The MPSAECK is indicated for use when the last sexual contact occurred within a 72 hour period. This "child friendly" kit was developed according to "do no harm principles" and contains a series of envelopes and cotton-tipped swabs that are used to gently swab the external portions of the child's body for forensic evidence such as saliva, semen, skin cells and other foreign material. All evidence collection steps are non-invasive and should not cause discomfort. Timely evidence collection using the MPSAECK is critical as forensic evidence in young children disappears quickly. Therefore, when the last sexual contact occurred within a 72 hour period, the child should be referred to a local emergency department for forensic evidence collection. The emergency department clinician should then make a referral to a Pediatric SANE for follow-up and a Medscope exam.
What is the cost of Pediatric SANE services?
There is no cost to a child or family for Pediatric SANE services as funds for these services are provided by the state. In cases in which testing for Sexually Transmitted Infections (STIs) is indicated, the child's medical insurance is billed for laboratory testing. In cases in which the child has no insurance, the Pediatric SANE will work with the laboratory to make provisions for free care .
When should medical providers and school nurses access emergency department services following disclosures of sexual abuse?
- Children < 12 years
If a child is < than 12 years and the abuse occurred within 72 hours, or if a child is complaining of pain or bleeding, the child should be seen urgently to assess for injuries and to collect forensic evidence that may be on the child's body and clothing. If the abuse involves oral, vaginal or rectal penetration by a penis, other body part or object, or if there is a concern of bodily secretions (saliva, semen etc) on the child's body or clothing, forensic evidence collection is indicated and should be done as soon as possible. Most Massachusetts emergency departments who provide care for children have access to the MA Pediatric Sexual Assault Evidence Collection Kit (for patients < 12 years), and have been trained by the Pedi SANE Program to use these kits as indicated. Pediatric SANE services are also available in the emergency department at Lawrence General Hospital on a 24/7 basis for all children who live in that geographical location.
During normal business hours, with guardian consent, primary care medical providers may also contact a local Children's Advocacy Center (CAC) Pediatric SANE to see if it is possible to complete the examination and forensic evidence collection on-site at the CAC instead of an emergency department. This on-site CAC option is not available for children 12 years and older due to differences in evidence collection and medication requirements.
- Children 12 years and older
If a child is 12 years or older and the abuse occurred within 120 hours, or the child is complaining of bleeding or pain, the child should be seen urgently to assess for injuries and to collect forensic evidence that may be on the child's body and clothing. If the abuse involves oral, vaginal or rectal penetration by a penis, other body part or object, or if there is a concern of bodily secretions (saliva, semen etc) on the child's body or clothing, forensic evidence collection is indicated and should be done as soon as possible. All emergency departments in Massachusetts have access and have been trained to use the MA Sexual Assault Evidence Collection Kit (for patients 12 years and older). In addition, the following facilities are MA designated SANE sites where Adult and Adolescent SANE services are available to care for patients 12 years and older on a 24/7 basis.
- Boston Medical Center
- Brigham and Women's
- Beth Israel Deaconess
- Cambridge Hospital
- Children's Hospital - Boston
- Massachusetts General Hospital
- Newton Wellesley Hospital
Cape and Islands
- Falmouth Hospital
- Cape Cod Hospital
- Nantucket Cottage Hospital
- Harrington Memorial Hospital
- Milford Regional Medical Center
- Worcester Medical Center
- UMASS Memorial Hospital
- UMASS University Hospital
- Lawrence General Hospital
- Brockton Hospital
- Charlton Memorial Hospital
- St. Luke's Hospital
- Morton Medical Center
- Tobey Hospital
- Jordan Hospital
- UMASS Amherst University Health Services
- Baystate Medical Center
- Cooley Dickinson Hospital
- Mercy Medical Center
- Wing Memorial Hospital