Frequently Asked Questions

For Parents of Children & Adolescents

Who needs a medical-forensic evaluation?


At The Cottage, our providers follow the nationally recognized, evidence-based guidelines established for the care of abused children and adolescents. According to those guidelines, if there is any suspicion, regardless of whether or not the child or adolescent makes a disclosure or denial, should have a medical-forensic examination performed by a properly trained, pediatric medical-forensic provider in a child-friendly environment. To ensure the safety, health, and well-being of these children and adolescents, they should all have specialized medical-forensic examinations in the absence of disclosure and even when they deny any history of abuse.

Those guidelines also recommend that all “contact children” also have a medical-forensic examination conducted by a properly trained pediatric medical-forensic provider. A “contact child” is any child or adolescent who has also had any type of in-person contact with the alleged perpetrator. To ensure the safety, health, and well-being of these children and adolescents, they should all have specialized medical-forensic examinations in the absence of disclosure and even when they deny any history of abuse.

ALL children and adolescents residing in a home or who frequently visits a home where child pornography was discovered/confiscated should be scheduled for a medical-forensic evaluation with a properly trained, pediatric medical-forensic provider. To ensure the safety, health, and well-being of these children and adolescents, they should all have specialized medical-forensic examinations in the absence of disclosure and even when they deny any history of abuse.




Why does my child/adolescent need a medical evaluation?


At The Cottage, our providers follow the nationally recognized, evidence-based guidelines established for the care of abused children and adolescents. According to those guidelines, if there is any suspicion, regardless of whether or not the child or adolescent makes a disclosure or denial, should have a medical-forensic examination performed by a properly trained, pediatric medical-forensic provider in a child-friendly environment. To ensure the safety, health, and well-being of these children and adolescents, they should all have specialized medical-forensic examinations in the absence of disclosure and even when they deny any history of abuse.

Those guidelines also recommend that all “contact children” also have a medical-forensic examination. A “contact child” is any child or adolescent who has also had any type of in-person contact with the alleged perpetrator. To ensure the safety, health, and well-being of these children and adolescents, they should all have specialized medical-forensic examinations in the absence of disclosure and even when they deny any history of abuse.

ALL children and adolescents residing in a home or who frequently visits a home where child pornography was discovered/confiscated should be scheduled for a medical-forensic evaluation with a properly trained, pediatric medical-forensic provider. To ensure the safety, health, and well-being of these children and adolescents, they should all have specialized medical-forensic examinations in the absence of disclosure and even when they deny any history of abuse.

Pediatric medical-forensic providers have special equipment and specialized training to perform and document forensic-medical examinations on child and adolescent patients. The main objective of the medical-forensic evaluation is to ensure the health and well-being of the child or adolescent. Children and adolescents who have been abused often worry that they are different from their peers. The medical-forensic exam will help to reassure your child or adolescent that everything is okay with their body, and it also provides an opportunity to document any significant physical and forensic findings, which may be utilized as evidence in investigations and legal proceedings to convict or exonerate the accused. Our providers at The Cottage are highly trained and experienced in diagnosing and treating medical conditions related to abuse and also distinguishing these conditions from those that mimic abuse.




Will the exam show if my child/adolescent has been sexually abused?


Not necessarily. Most children and adolescents have no physical injuries in their genital and/or anal area following abuse, and the majority of exams result in a normal, healthy finding for your child or adolescent. Please understand, this does not mean or “prove” that no sexual abuse or contact occurred. The medical exam may, however, help to corroborate the patient’s disclosures or support any suspicions or allegations.




What happens after the exam?


After the examination the medical-forensic provider will discuss any further medical testing, medications, and/or follow-up care that may be warranted. The provider will also discuss what other steps need to be taken and place referrals for any additional services you and your child or adolescent may need. With your consent, the medical-forensic provider will discuss the findings of the examination with the agencies investigating the matter (ie: law enforcement, DFCS).




What should I tell my child/adolescent after the exam?


Help your child/adolescent to understand that he/she does not have to share private information about their body with other family or friends if they do not wish to do so.

If your child is young, please also help him/her to also understand this exam was not a game to be played with others. There are links available in the “Patient and Family Resources” area of our website that can help you explain the importance of privacy and “safe” or appropriate touch to your child.




What should I do if I suspect that my child or adolescent has been abused?


1. Remain calm and listen attentively to what he/she has to say, but do not solicit details or ask probing or leading questions about the disclosures. It is important to allow specifically trained professionals to obtain the details from children and adolescents. Treat the child or adolescent as you normally do. Speaking softly and in a caring tone, communicate to the child/adolescent that he/she did the right thing by telling you, and you will call someone who can help. 2. Immediately contact local law enforcement officials and the Georgia Department of Child and Family Services (DFCS), and work closely with those agencies to ensure the protection of your child or adolescent. 3. Seek proper medical treatment for your child or adolescent from a forensic-medical provider specifically trained to care for pediatric victims of abuse, even if it has been years since the last alleged incident of abuse, and even if no one else involved in the process has recommended that you do so. 4. Seek counseling services for your child/adolescent, as well as yourself or anyone else in your family who may need these services. 5. Seek financial assistance and/or reimbursement for expenses through the Georgia Crime Victim’s Compensation Program. This assistance and/or reimbursement will help you afford the care your child or adolescent and family will need to heal from the trauma of abuse.




Where can I get counseling for my child/adolescent?


The staff at The Cottage will assist you in locating a counselor close to your home in your local community/area so that it is feasible and accessible to you and your family.




Will my child/adolescent be required to go to court and testify?


This is a question you will need to discuss with the prosecutor assigned to the criminal case.




Are there financial resources available to help pay for treatment and counseling if my child or adolescent has been abused?


Financial resources are available to crime victims under the Georgia Crime Victims Compensation Program. Find information about the program and find out if you may qualify for assistance through that program by clicking here: http://crimevictimscomp.ga.gov/for-victims/

Our staff at The Cottage will be happy to assist you with filing for any benefits you may be entitled to under the program.




What should I tell child/adolescent before our visit to The Cottage?


We request that you not ask your child/adolescent any further questions about the incident; however, listen if he/she voluntarily offers information to you. Our staff can address any concerns you or your child/adolescent may have when you arrive for the appointment.

Prior to your appointment at The Cottage, you should let your child or adolescent know that you will be taking him/her for a medical check-up, explaining to him/her that it is similar to a check-up at their pediatrician’s office. Some children are embarrassed about having a medical exam. It is helpful to explain to your child or adolescent that our provider is there to make sure his/her body is okay and to keep them healthy. Reassure them there is nothing to be afraid of. There is no pain associated with the medical examination process, and no shots are given at The Cottage; however, the provider may recommend further testing, medications, and/or immunizations after the visit.




What, exactly, do you do for children and adolescents at The Cottage?


What we DO for children and adolescents at The Cottage:

  • We provide crisis intervention.
  • We provide initial and follow-up care to suspected child and adolescent victims of abuse.
  • We take a medical history, as well as a history related to why the patient was referred to The Cottage.
  • We complete physical examinations.
  • We may use special equipment to better visualize the anal and genital areas.
  • We may briefly talk with your child or adolescent alone.
  • We test for sexually transmitted infections and pregnancy, if indicated.
  • We provide referrals for mental health and other services in the community in which the family resides so it is feasible and accessible.
  • Provide information on the Georgia Crime Victim’s Compensation Program to parents and caregivers, and we assist them with filing for benefits through that program, if necessary.

What we DO NOT do for children and adolescents at The Cottage:

  • We do not perform “internal” or invasive exams of children or young adolescents.
  • At the present time, we generally do not conduct comprehensive forensic interviews with children and young teens/adolescents; however, we do work closely with a multidisciplinary team to ensure that our patients and their families receive the services they need.




What is the cost of care at The Cottage?


There is no charge to the patient or the family for the initial care of any child or adolescent with a complaint of sexual abuse at The Cottage.

The cost of care for child and adolescent patients evaluated for physical abuse or neglect (without a component of sexual abuse) will be billed to the child’s health insurance plan. If the pediatric patient does not have insurance coverage, we are not set up for reimbursement under their plan, or their plan requires payment of a co-pay and/or deductible, we will assist the family with filing for benefits and reimbursement for charges under the state crime victim’s compensation program.

Most children and adolescents only require one visit with the providers at The Cottage; however, if follow-up visits are required for your child or adolescent, the cost of that care will be billed to the child’s health insurance plan. If the pediatric patient does not have insurance coverage, we are not set up for reimbursement under their plan, or their plan requires payment of a co-pay and/or deductible, we will assist the family with filing for benefits and reimbursement for charges under the state crime victim’s compensation program.




What type of medical care is provided at The Cottage?


At the Cottage, we provide initial and follow-up medical-forensic care to child and adolescent victims of all forms of abuse. Follow-up visits can often be done via telemedicine from the comfort of your own home.




What will happen during our visit to The Cottage?


Patients seen at The Cottage usually have no wait time, as we provide individualized, patient-centered care, and because of that, expect the entire visit to our clinic to be as long as 1-2 hours. If you pre-register through the online patient portal at least 24 hours prior to your appointment time, however, the length of your appointment will likely be greatly reduced. Upon arrival, the medical-forensic provider will spend some time with you collecting your child or adolescent’s medical history. If you provided this information through the online patient portal prior to your visit, we will only need to briefly review this information to ensure it is complete and accurate. We will also explain the examination process to you, answer any questions you may have for us, and ask you to sign the consent forms to perform the examination.

Our provider will also make sure your child or adolescent understands that he/she will have a physical examination, what that process will entail, attempt to alleviate any fears or anxiety related to it, and address any questions or concerns he/she may have. Depending on the age and developmental level of the patient, the provider may ask to speak briefly with him/her alone.

When it is time for the medical examination, we leave it up to the patient to determine who they would like to have in the room. Some children and adolescents want their parent(s) in the room, while some do not. We try to give as much control as we possibly can to the patient in these situations. When parents or caregivers are in the room during the examination, regardless of the age or developmental level of the patient, they are asked to focus on supporting their child/adolescent. We also ask any support person in the room with the patient to refrain from asking questions about physical findings or answering questions the provider asks the patient.

Our medical provider will weigh, measure, take vital signs, and perform a complete head-to-toe physical examination on the patient. No part of the physical exam should cause your child or adolescent any pain. The genital exam involves an external look at your child or adolescent’s genital area utilizing a special instrument called a colposcope. This instrument provides good light and magnification to facilitate better visualization of all structures. The colposcope does not touch the patient’s body in any way, nor is it felt by the patient; however, the provider will need to touch the patient’s genital and anal areas to facilitate proper visualization of all external structures. It is important for you and your child or adolescent to understand that the genital exam is very different and far less invasive than an adult pelvic exam, and it is absolutely in no way comparable to a “pap smear.” Vaginal speculums are not inserted inside children and young adolescents. Patients are never forced, and they are given as much time as necessary to feel comfortable with the exam. If your child or adolescent is very resistant, the exam can be rescheduled for a later date or not done at all. Most children and adolescents are cooperative when they reassured that the decision to have the exam is ultimately their own. Please be assured that your child or adolescent will always be treated with dignity and respect.

After the examination we will discuss whether your child or adolescent will need additional medical care, such as lab testing, x-rays, medications, immunizations, and/or follow-up examinations. We will also discuss what other steps need to be taken and place referrals for any additional services you and your child or adolescent may need.




What does the colposcope look like?





What happens during the medical-forensic examination?


Our medical providers will weigh, measure, take vital signs, and perform a complete head-to-toe physical examination on the patient. No part of the physical exam should cause your child or adolescent any pain. The genital exam involves an external look at your child or adolescent’s genital area utilizing a special instrument called a colposcope. This instrument provides good light and magnification to facilitate better visualization of all structures. The colposcope does not touch the patient’s body in any way, nor is it felt by the patient; however, the provider will need to touch the patient’s genital and anal areas to facilitate proper visualization of all external structures. It is important for you and your child or adolescent to understand that the genital exam is very different and far less invasive than an adult pelvic exam, and it is absolutely in no way comparable to a “pap smear.” Vaginal speculums are not inserted inside children and young adolescents. Patients are never forced, and they are given as much time as necessary to feel comfortable with the exam. If your child or adolescent is very resistant, the exam can be rescheduled for a later date or not done at all. Most children and adolescents are cooperative when they reassured that the decision to have the exam is ultimately their own. Please be assured that your child or adolescent will always be treated with dignity and respect.




Will the medical-forensic examination hurt, cause any pain, or traumatize my child/adolescent in any way?


No part of the medical-forensic examination should cause your child or adolescent any pain. It is important for you and your child or adolescent to understand that the genital exam is very different and far less invasive than an adult pelvic exam, and it is absolutely in no way comparable to a “pap smear.” Vaginal speculums are not inserted inside children and young adolescents.

Patients are never forced, and they are given as much time as necessary to feel comfortable with the exam. If your child or adolescent is very resistant, the exam can be rescheduled for a later date or not done at all. Most children and adolescents are cooperative when they reassured that the decision to have the exam is ultimately their own. Please be assured that your child or adolescent will always be treated with dignity and respect.




Can I just take my child/adolescent to his/her regular doctor or pediatrician?


Most pediatric and family practice primary care and urgent care offices and clinics are not comfortable with managing cases of suspected child abuse, particularly suspected cases of child or adolescent sexual abuse, and most of those offices and clinics do not have the specialized equipment to properly perform and document these examinations. Additionally, many providers in those settings are not trained to provide the sub-specialty care required in these cases.

At The Cottage, children receive sub-specialty care in a private, community-based, medical setting by providers who specialize in child abuse, and our patients and their families are provided with the support necessary to help them through the process.

Multiple examinations should be avoided; therefore, seeking care for your child from the appropriate specialist is essential.




Where and when should I seek care for my child/adolescent if I suspect or my child/adolescent discloses child sexual abuse?


In cases of suspected child and adolescent sexual abuse, knowing when to seek emergency medical treatment in an emergency department (ED) setting is important. Community-based medical-forensic centers like The Cottage is the ideal and preferred setting for evaluating suspected child victims of sexual abuse who are medically stable. In many situations, a parent or caregiver learns that the abuse has been longstanding or may have occurred or stopped quite some time prior to the child or adolescent’s disclosure. While proper services for both the patient and family are needed as soon as possible, this type of disclosure is rarely a medical emergency. To protect the patient from unnecessary upset and traumatization, evaluation in an ED for child or adolescent sexual abuse should be reserved only for true emergencies that require immediate medical attention. When no qualified provider is immediately available at The Cottage, urgent evaluation in an ED should be considered when any child or adolescent who has disclosed sexual contact that occurred within the previous 72 hours (3 days) OR any child or young adolescent who has been observed engaging in sexual contact within the previous 72 hours (3 days). Any child or adolescent with acute genital or anal injuries, physical injuries that may require stitches, suspected fractures or dislocations, head injuries, memory loss, reports strangulation within the past 3-4 days, or any other acute, serious, or life-threatening injury or illness should be evaluated and medically cleared and stable prior to being seen by the medical-forensic provider at The Cottage. Once the patient is stable and discharged from the ED or hospital, he/she can be seen at The Cottage for a proper medical-forensic examination.




What should we bring to our visit at The Cottage?


1. Proof of guardianship such as custody papers (if you are not the child’s parent).

2. Another adult to support you and your child and to sit with your child while you speak with the treatment team at The Cottage, if at all possible.

3. The child’s insurance card(s) - ONLY IF the child is covered under a health insurance plan AND the appointment is not for an initial sexual abuse evaluation (ie: the evaluation is for suspected physical abuse or neglect or is a follow-up visit).

IMPORTANT NOTE: The Cottage does not allow suspected or alleged perpetrators or non-supportive caregivers on the premises, so please plan accordingly.





 
 

For Adolescents

Who needs a medical-forensic evaluation?


At The Cottage, our providers follow the nationally recognized, evidence-based guidelines established for the care of abused children and adolescents. According to those guidelines, if there is any suspicion, regardless of whether or not the child or adolescent makes a disclosure or denial, should have a medical-forensic examination performed by a properly trained, pediatric medical-forensic provider in a child-friendly environment. To ensure the safety, health, and well-being of these children and adolescents, they should all have specialized medical-forensic examinations in the absence of disclosure and even when they deny any history of abuse.

Those guidelines also recommend that all “contact children” also have a medical-forensic examination conducted by a properly trained pediatric medical-forensic provider. A “contact child” is any child or adolescent who has also had any type of in-person contact with the alleged perpetrator. To ensure the safety, health, and well-being of these children and adolescents, they should all have specialized medical-forensic examinations in the absence of disclosure and even when they deny any history of abuse.

ALL children and adolescents residing in a home or who frequently visits a home where child pornography was discovered/confiscated should be scheduled for a medical-forensic evaluation with a properly trained, pediatric medical-forensic provider. To ensure the safety, health, and well-being of these children and adolescents, they should all have specialized medical-forensic examinations in the absence of disclosure and even when they deny any history of abuse.




Why does my child/adolescent need a medical evaluation?


At The Cottage, our providers follow the nationally recognized, evidence-based guidelines established for the care of abused children and adolescents. According to those guidelines, if there is any suspicion, regardless of whether or not the child or adolescent makes a disclosure or denial, should have a medical-forensic examination performed by a properly trained, pediatric medical-forensic provider in a child-friendly environment. To ensure the safety, health, and well-being of these children and adolescents, they should all have specialized medical-forensic examinations in the absence of disclosure and even when they deny any history of abuse.

Those guidelines also recommend that all “contact children” also have a medical-forensic examination. A “contact child” is any child or adolescent who has also had any type of in-person contact with the alleged perpetrator. To ensure the safety, health, and well-being of these children and adolescents, they should all have specialized medical-forensic examinations in the absence of disclosure and even when they deny any history of abuse.

ALL children and adolescents residing in a home or who frequently visits a home where child pornography was discovered/confiscated should be scheduled for a medical-forensic evaluation with a properly trained, pediatric medical-forensic provider. To ensure the safety, health, and well-being of these children and adolescents, they should all have specialized medical-forensic examinations in the absence of disclosure and even when they deny any history of abuse.

Pediatric medical-forensic providers have special equipment and specialized training to perform and document forensic-medical examinations on child and adolescent patients. The main objective of the medical-forensic evaluation is to ensure the health and well-being of the child or adolescent. Children and adolescents who have been abused often worry that they are different from their peers. The medical-forensic exam will help to reassure your child or adolescent that everything is okay with their body, and it also provides an opportunity to document any significant physical and forensic findings, which may be utilized as evidence in investigations and legal proceedings to convict or exonerate the accused. Our providers at The Cottage are highly trained and experienced in diagnosing and treating medical conditions related to abuse and also distinguishing these conditions from those that mimic abuse.




Will the exam show if my child/adolescent has been sexually abused?


Not necessarily. Most children and adolescents have no physical injuries in their genital and/or anal area following abuse, and the majority of exams result in a normal, healthy finding for your child or adolescent. Please understand, this does not mean or “prove” that no sexual abuse or contact occurred. The medical exam may, however, help to corroborate the patient’s disclosures or support any suspicions or allegations.




What happens after the exam?


After the examination the medical-forensic provider will discuss any further medical testing, medications, and/or follow-up care that may be warranted. The provider will also discuss what other steps need to be taken and place referrals for any additional services you and your child or adolescent may need. With your consent, the medical-forensic provider will discuss the findings of the examination with the agencies investigating the matter (ie: law enforcement, DFCS).




What should I tell my child/adolescent after the exam?


Help your child/adolescent to understand that he/she does not have to share private information about their body with other family or friends if they do not wish to do so.

If your child is young, please also help him/her to also understand this exam was not a game to be played with others. There are links available in the “Patient and Family Resources” area of our website that can help you explain the importance of privacy and “safe” or appropriate touch to your child.




What should I do if I suspect that my child or adolescent has been abused?


1. Remain calm and listen attentively to what he/she has to say, but do not solicit details or ask probing or leading questions about the disclosures. It is important to allow specifically trained professionals to obtain the details from children and adolescents. Treat the child or adolescent as you normally do. Speaking softly and in a caring tone, communicate to the child/adolescent that he/she did the right thing by telling you, and you will call someone who can help. 2. Immediately contact local law enforcement officials and the Georgia Department of Child and Family Services (DFCS), and work closely with those agencies to ensure the protection of your child or adolescent. 3. Seek proper medical treatment for your child or adolescent from a forensic-medical provider specifically trained to care for pediatric victims of abuse, even if it has been years since the last alleged incident of abuse, and even if no one else involved in the process has recommended that you do so. 4. Seek counseling services for your child/adolescent, as well as yourself or anyone else in your family who may need these services. 5. Seek financial assistance and/or reimbursement for expenses through the Georgia Crime Victim’s Compensation Program. This assistance and/or reimbursement will help you afford the care your child or adolescent and family will need to heal from the trauma of abuse.




Where can I get counseling for my child/adolescent?


The staff at The Cottage will assist you in locating a counselor close to your home in your local community/area so that it is feasible and accessible to you and your family.




Will my child/adolescent be required to go to court and testify?


This is a question you will need to discuss with the prosecutor assigned to the criminal case.




Are there financial resources available to help pay for treatment and counseling if my child or adolescent has been abused?


Financial resources are available to crime victims under the Georgia Crime Victims Compensation Program. Find information about the program and find out if you may qualify for assistance through that program by clicking here: http://crimevictimscomp.ga.gov/for-victims/

Our staff at The Cottage will be happy to assist you with filing for any benefits you may be entitled to under the program.




What should I tell child/adolescent before our visit to The Cottage?


We request that you not ask your child/adolescent any further questions about the incident; however, listen if he/she voluntarily offers information to you. Our staff can address any concerns you or your child/adolescent may have when you arrive for the appointment.

Prior to your appointment at The Cottage, you should let your child or adolescent know that you will be taking him/her for a medical check-up, explaining to him/her that it is similar to a check-up at their pediatrician’s office. Some children are embarrassed about having a medical exam. It is helpful to explain to your child or adolescent that our provider is there to make sure his/her body is okay and to keep them healthy. Reassure them there is nothing to be afraid of. There is no pain associated with the medical examination process, and no shots are given at The Cottage; however, the provider may recommend further testing, medications, and/or immunizations after the visit.




What, exactly, do you do for children and adolescents at The Cottage?


What we DO for children and adolescents at The Cottage:

  • We provide crisis intervention.
  • We provide initial and follow-up care to suspected child and adolescent victims of abuse.
  • We take a medical history, as well as a history related to why the patient was referred to The Cottage.
  • We complete physical examinations.
  • We may use special equipment to better visualize the anal and genital areas.
  • We may briefly talk with your child or adolescent alone.
  • We test for sexually transmitted infections and pregnancy, if indicated.
  • We provide referrals for mental health and other services in the community in which the family resides so it is feasible and accessible.
  • Provide information on the Georgia Crime Victim’s Compensation Program to parents and caregivers, and we assist them with filing for benefits through that program, if necessary.

What we DO NOT do for children and adolescents at The Cottage:

  • We do not perform “internal” or invasive exams of children or young adolescents.
  • At the present time, we generally do not conduct comprehensive forensic interviews with children and young teens/adolescents; however, we do work closely with a multidisciplinary team to ensure that our patients and their families receive the services they need.




What is the cost of care at The Cottage?


There is no charge to the patient or the family for the initial care of any child or adolescent with a complaint of sexual abuse at The Cottage.

The cost of care for child and adolescent patients evaluated for physical abuse or neglect (without a component of sexual abuse) will be billed to the child’s health insurance plan. If the pediatric patient does not have insurance coverage, we are not set up for reimbursement under their plan, or their plan requires payment of a co-pay and/or deductible, we will assist the family with filing for benefits and reimbursement for charges under the state crime victim’s compensation program.

Most children and adolescents only require one visit with the providers at The Cottage; however, if follow-up visits are required for your child or adolescent, the cost of that care will be billed to the child’s health insurance plan. If the pediatric patient does not have insurance coverage, we are not set up for reimbursement under their plan, or their plan requires payment of a co-pay and/or deductible, we will assist the family with filing for benefits and reimbursement for charges under the state crime victim’s compensation program.




What type of medical care is provided at The Cottage?


At the Cottage, we provide initial and follow-up medical-forensic care to child and adolescent victims of all forms of abuse. Follow-up visits can often be done via telemedicine from the comfort of your own home.




What will happen during our visit to The Cottage?


Patients seen at The Cottage usually have no wait time, as we provide individualized, patient-centered care, and because of that, expect the entire visit to our clinic to be as long as 1-2 hours. If you pre-register through the online patient portal at least 24 hours prior to your appointment time, however, the length of your appointment will likely be greatly reduced. Upon arrival, the medical-forensic provider will spend some time with you collecting your child or adolescent’s medical history. If you provided this information through the online patient portal prior to your visit, we will only need to briefly review this information to ensure it is complete and accurate. We will also explain the examination process to you, answer any questions you may have for us, and ask you to sign the consent forms to perform the examination.

Our provider will also make sure your child or adolescent understands that he/she will have a physical examination, what that process will entail, attempt to alleviate any fears or anxiety related to it, and address any questions or concerns he/she may have. Depending on the age and developmental level of the patient, the provider may ask to speak briefly with him/her alone.

When it is time for the medical examination, we leave it up to the patient to determine who they would like to have in the room. Some children and adolescents want their parent(s) in the room, while some do not. We try to give as much control as we possibly can to the patient in these situations. When parents or caregivers are in the room during the examination, regardless of the age or developmental level of the patient, they are asked to focus on supporting their child/adolescent. We also ask any support person in the room with the patient to refrain from asking questions about physical findings or answering questions the provider asks the patient.

Our medical provider will weigh, measure, take vital signs, and perform a complete head-to-toe physical examination on the patient. No part of the physical exam should cause your child or adolescent any pain. The genital exam involves an external look at your child or adolescent’s genital area utilizing a special instrument called a colposcope. This instrument provides good light and magnification to facilitate better visualization of all structures. The colposcope does not touch the patient’s body in any way, nor is it felt by the patient; however, the provider will need to touch the patient’s genital and anal areas to facilitate proper visualization of all external structures. It is important for you and your child or adolescent to understand that the genital exam is very different and far less invasive than an adult pelvic exam, and it is absolutely in no way comparable to a “pap smear.” Vaginal speculums are not inserted inside children and young adolescents. Patients are never forced, and they are given as much time as necessary to feel comfortable with the exam. If your child or adolescent is very resistant, the exam can be rescheduled for a later date or not done at all. Most children and adolescents are cooperative when they reassured that the decision to have the exam is ultimately their own. Please be assured that your child or adolescent will always be treated with dignity and respect.

After the examination we will discuss whether your child or adolescent will need additional medical care, such as lab testing, x-rays, medications, immunizations, and/or follow-up examinations. We will also discuss what other steps need to be taken and place referrals for any additional services you and your child or adolescent may need.




What does the colposcope look like?





What happens during the medical-forensic examination?


Our medical providers will weigh, measure, take vital signs, and perform a complete head-to-toe physical examination on the patient. No part of the physical exam should cause your child or adolescent any pain. The genital exam involves an external look at your child or adolescent’s genital area utilizing a special instrument called a colposcope. This instrument provides good light and magnification to facilitate better visualization of all structures. The colposcope does not touch the patient’s body in any way, nor is it felt by the patient; however, the provider will need to touch the patient’s genital and anal areas to facilitate proper visualization of all external structures. It is important for you and your child or adolescent to understand that the genital exam is very different and far less invasive than an adult pelvic exam, and it is absolutely in no way comparable to a “pap smear.” Vaginal speculums are not inserted inside children and young adolescents. Patients are never forced, and they are given as much time as necessary to feel comfortable with the exam. If your child or adolescent is very resistant, the exam can be rescheduled for a later date or not done at all. Most children and adolescents are cooperative when they reassured that the decision to have the exam is ultimately their own. Please be assured that your child or adolescent will always be treated with dignity and respect.




Will the medical-forensic examination hurt, cause any pain, or traumatize my child/adolescent in any way?


No part of the medical-forensic examination should cause your child or adolescent any pain. It is important for you and your child or adolescent to understand that the genital exam is very different and far less invasive than an adult pelvic exam, and it is absolutely in no way comparable to a “pap smear.” Vaginal speculums are not inserted inside children and young adolescents.

Patients are never forced, and they are given as much time as necessary to feel comfortable with the exam. If your child or adolescent is very resistant, the exam can be rescheduled for a later date or not done at all. Most children and adolescents are cooperative when they reassured that the decision to have the exam is ultimately their own. Please be assured that your child or adolescent will always be treated with dignity and respect.




Can I just take my child/adolescent to his/her regular doctor or pediatrician?


Most pediatric and family practice primary care and urgent care offices and clinics are not comfortable with managing cases of suspected child abuse, particularly suspected cases of child or adolescent sexual abuse, and most of those offices and clinics do not have the specialized equipment to properly perform and document these examinations. Additionally, many providers in those settings are not trained to provide the sub-specialty care required in these cases.

At The Cottage, children receive sub-specialty care in a private, community-based, medical setting by providers who specialize in child abuse, and our patients and their families are provided with the support necessary to help them through the process.

Multiple examinations should be avoided; therefore, seeking care for your child from the appropriate specialist is essential.




Where and when should I seek care for my child/adolescent if I suspect or my child/adolescent discloses child sexual abuse?


In cases of suspected child and adolescent sexual abuse, knowing when to seek emergency medical treatment in an emergency department (ED) setting is important. Community-based medical-forensic centers like The Cottage is the ideal and preferred setting for evaluating suspected child victims of sexual abuse who are medically stable. In many situations, a parent or caregiver learns that the abuse has been longstanding or may have occurred or stopped quite some time prior to the child or adolescent’s disclosure. While proper services for both the patient and family are needed as soon as possible, this type of disclosure is rarely a medical emergency. To protect the patient from unnecessary upset and traumatization, evaluation in an ED for child or adolescent sexual abuse should be reserved only for true emergencies that require immediate medical attention. When no qualified provider is immediately available at The Cottage, urgent evaluation in an ED should be considered when any child or adolescent who has disclosed sexual contact that occurred within the previous 72 hours (3 days) OR any child or young adolescent who has been observed engaging in sexual contact within the previous 72 hours (3 days). Any child or adolescent with acute genital or anal injuries, physical injuries that may require stitches, suspected fractures or dislocations, head injuries, memory loss, reports strangulation within the past 3-4 days, or any other acute, serious, or life-threatening injury or illness should be evaluated and medically cleared and stable prior to being seen by the medical-forensic provider at The Cottage. Once the patient is stable and discharged from the ED or hospital, he/she can be seen at The Cottage for a proper medical-forensic examination.




What should we bring to our visit at The Cottage?


1. Proof of guardianship such as custody papers (if you are not the child’s parent).

2. Another adult to support you and your child and to sit with your child while you speak with the treatment team at The Cottage, if at all possible.

3. The child’s insurance card(s) - ONLY IF the child is covered under a health insurance plan AND the appointment is not for an initial sexual abuse evaluation (ie: the evaluation is for suspected physical abuse or neglect or is a follow-up visit).

IMPORTANT NOTE: The Cottage does not allow suspected or alleged perpetrators or non-supportive caregivers on the premises, so please plan accordingly.





For Adults

Will the exam prove that I was sexually assaulted?


Not necessarily. Many adolescents and adults have no physical injuries in their genital and/or anal area after a sexual assault. Please understand, this does not mean or “prove” that you were not sexually assaulted. It is also important to note that the presence of injury(ies) does not necessarily "prove" sexual assault either. The medical-forensic exam may, however, provide evidence to corroborate your allegations. Also, injuries in the genital and anal area tend to heal very quickly; therefore, it is important to seek care as soon as possible after a sexual assault.




What happens after the exam?


After the examination our medical-forensic provider will discuss with you a plan of care that may include the need for additional medical care, such as lab testing for sexually transmitted infections (STI) and pregnancy, x-rays, medications, immunizations, and/or follow-up examinations and where and how to obtain that care. Our provider will also discuss what other steps need to be taken and place referrals for any additional services you may need to facilitate proper healing after the sexual assault. With your consent, the medical-forensic provider will discuss the findings of the examination with the agencies investigating the matter.




Where can I get counseling or mental health services?


The staff at The Cottage will assist you in locating a counselor or mental health provider close to your home in your local community/area so that it is feasible for you to access and utilize use these services.




Will I be required to go to court and testify?


This is a question you will need to discuss with the prosecutor assigned to the criminal case.




Are there financial resources available to help me pay for treatment and counseling?


Financial resources are available to crime victims under the Georgia Crime Victims Compensation Program. Find information about the program and find out if you may qualify for assistance through that program by clicking here: http://crimevictimscomp.ga.gov/for-victims/

Our staff at The Cottage will be happy to assist you with filing for any benefits you may be entitled to under the program.




What is sexual assault?


Sexual assault is any type of sexual activity or sexual contact that occurs without mutual consent. This activity or contact includes, but is not limited to:

  • Any type of sexual contact to which one of the parties did not provide consent.

  • Any type of sexual contact with any individual who is unable to legally provide consent. This includes any minor under the age of 16 in the state of Georgia, individuals with an intellectual disability, individuals who are intoxicated or high, any individual who is unable to respond (ie: sleeping, unconscious, etc.).

  • Rape or attempted rape.

  • Sexual coercion.

  • Fondling, “groping,” and any other nonconsensual touching above or under the clothes.

Sexual assault can also include non-contact activities, these activities include, but are not limited to:

  • Voyeurism or “peeping.” This is when someone watches private sexual acts or watches someone getting undressed without consent.

  • Exhibitionism and “flashing.” This is when someone exposes their nude body to another individual without the other individual's consent.

  • Forcing someone to look at sexual images or video.

  • Taking images or video of someone without clothes on without their consent. Important Note: No one under the age of 18 can legally consent to this activity.

  • Sending someone unwanted texts or “sexts,” which are unwanted sexual photos and/or messages.

It is important for any individual who has been sexually assaulted to know that it is never their fault.




What is the cost of care at The Cottage?


There is no charge to sexual assault patients for an initial medical-forensic examination at The Cottage.




What type of medical care is provided to adults at The Cottage?


At the Cottage, we provide initial medical-forensic care to sexually assaulted adults, with referrals for any follow-up care and mental health needs to resources in the community.




What will happen during my visit to The Cottage?


The following is what adult sexual assault patients can expect when presenting to The Cottage for care:

  • All of our patients receive trauma-informed, high-quality, evidence-based, patient-centered care in a private, controlled, community-based setting.

  • You will be seen and evaluated by a highly trained and experienced medical-forensic examiner.

  • You will be asked to sign consents for the examination and treatment.

  • You will be asked to provide a medical history.

  • You will be asked to provide a detailed history of the sexual assault. This history may include, but is not limited to, details such as the date and time it occurred, where it occurred, name of the perpetrator, description of the perpetrator, what acts were perpetrated during the assault, how many times each act was perpetrated. what threats were made by the perpetrator, if a condom was utilized, and what hygiene measures you have taken since that time (ie: shower, bath, washed or brushed hair, brushed teeth, etc.).

  • If you are wearing the clothing you wore during the assault, you will be asked to provide it as evidence, and it will be placed into bags and turned over to law enforcement. If you have already changed clothes, you may be asked to provide your panties or underwear as evidence.

  • You will be asked to change into a gown.

  • If drugs (illicit and certain prescription medications) or alcohol were involved or it is suspected that you were given some type of drug involuntarily, you may also be asked to provide a blood sample.

  • You will have a head-to-toe physical examination performed by the medical-forensic provider. The provider may also look at your body with a florescent lamp that allows visualization of evidence that cannot be seen with the naked eye.

  • The medical-forensic provider may take photographs or video to document any bruises, scrapes, cuts, or other potential injuries identified during the physical examination process.

  • The medical-forensic provider will collect possible physical evidence from your body. This process is achieved by utilizing cotton swabs to collect possible evidence from different parts of your body, inside your mouth, and under your fingernails. Any debris identified on your skin may also be collected. The examiner will also examine the genital and anal areas for any injuries, including “micro injuries,” and collect possible evidence utilizing a cotton swab.

  • After the examination our medical-forensic provider will discuss with you a plan of care that may include the need for additional medical care, such as lab testing for sexually transmitted infections (STI) and pregnancy, x-rays, medications, immunizations, and/or follow-up examinations and where and how to obtain this care. Our provider will also discuss what other steps need to be taken and place referrals for any additional services you may need to facilitate proper healing after the sexual assault such as counseling or mental health services.

IMPORTANT NOTE: You can REFUSE any part(s) of the examination you so choose.




What does the colposcope look like?





Can I go see my regular doctor or the emergency department to get the care I need?


Most primary and urgent care offices and clinics are not comfortable managing sexual assault cases, and most of those offices do not have the specialized equipment or time built into their schedules to properly perform and document these examinations. Additionally, many providers in these settings are not trained to provide the sub-specialty care required in these cases, even if the patient chooses only to receive medical care without requesting evidence collection.

Emergency departments (ED) are very busy, and it is difficult to provide personalized and comprehensive care to sexual assault patients in those environments. Community-based medical-forensic centers like The Cottage is the ideal and preferred setting for evaluating medically stable sexual assault patients. To protect the patient from repeat traumatization, evaluation in an ED after a sexual assault should be reserved only for true emergencies that require immediate and emergent medical attention. When no qualified provider is immediately available at The Cottage, urgent evaluation in an ED should be considered if the assault occurred within the past 72 hours (3 days). Any patient with physical injuries that may require stitches, suspected fractures or dislocations, head injuries, memory loss, reports strangulation within the past 3-4 days, or any other acute, serious, or life-threatening injury or illness should be evaluated and medically cleared and stable prior to being seen by the medical-forensic provider at The Cottage. Once the patient is stable and discharged from the ED or hospital, he/she can be seen at The Cottage for a proper medical-forensic examination.

At The Cottage, our patients receive sub-specialty care in a private, community-based, medical setting by providers who specialize in providing care to sexual assault patients across the lifespan, and our patients are provided with the support necessary to help them through the process.




When and where should I seek care if I am sexually assaulted?


When you have been sexually assaulted, knowing when to seek emergency medical treatment in an emergency department (ED) setting is important. Community-based medical-forensic centers like The Cottage is the ideal and preferred setting for evaluating medically stable sexual assault patients. To protect the patient from repeat traumatization, evaluation in an ED after a sexual assault should be reserved only for true emergencies that require immediate and emergent medical attention.

When no qualified provider is immediately available at The Cottage, urgent evaluation in an ED should be considered if the assault occurred within the past 3-5 days.

Any patient with physical injuries that may require stitches, suspected fractures or dislocations, head injuries, memory loss, reports strangulation within the past 3-4 days, or any other acute, serious, or life-threatening injury or illness should be evaluated and medically cleared and stable prior to being seen by the medical-forensic provider at The Cottage. Once the patient is stable and discharged from the ED or hospital, he/she can be seen at The Cottage for a proper medical-forensic examination.




What should I do if I am sexually assaulted?


  1. If you are in immediate danger and/or in need of emergent medical care, call 911.
  2. If at all possible, get away from the person who assaulted you and get to a safe place as fast as you can, as your safety is the most important thing in this situation.
  3. Notify the police as soon as possible. If you are afraid to report to the police, seek assistance in a community-based victim service center or an emergency department where the professionals can assist you with making this report without walking into a police department.
  4. Do not change your clothes, clean any part of your body, douche, brush or comb your hair, brush your teeth, or eat or drink anything. Doing so may wash or brush away or destroy very important evidence.
  5. Seek care from a community-based victim service center with a qualified medical-forensic provider or go to the nearest emergency department to be examined, treated for injuries, be tested for potential sexually transmitted infections (STIs) and/or obtain prophylactic treatment for potential STI’s, and be tested for pregnancy and/or obtain emergency contraception. If the assault occurred within the past 3-5 days, you should be offered the option to have evidence collected utilizing a sexual assault evidence collection kit. This care should be provided to you FREE of charge without a requirement that you cooperate with the police investigation.
  6. If you were impaired by drugs or alcohol or believe you may have been given a drug without your knowledge, be sure to inform the medical provider immediately upon arrival so that particular evidence can be collected quickly, as these substances typically pass through the body rather quickly.
  7. You are not required to cooperate with the police to have your medical needs and personal safety addressed or have an evidence collection kit collected.




Who needs a medical-forensic evaluation?


Any patient who believes they have been assaulted in any way and have not yet had an examination by a properly trained medical-forensic examiner.




Can I be sexually assaulted by my boyfriend/girlfriend, partner, spouse, significant other, ex, or a family member?


Yes. Sexual assault is any sexual activity or contact to which an individual does not provide or is unable to provide consent, no matter who it is with. In fact, this is not at all an uncommon occurence. Sexual assault is often perpetrated by someone the victim knows, which may include a friend, family member, acquaintance, date, or current or ex-spouse or ex-intimate partner (Smith et al., 2017).

Reference:

Smith, S.G., Chen, J., Basile, K.C., Gilbert, L.K., Merrick, M.T., Patel, N., et al. (2017). The National Intimate Partner and Sexual Violence Survey: 2010-2012 State Report. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.




What is consent?


Consent is clearly indicating “yes” to sexual activity or contact. Failure to say “no” does not necessarily mean consent has been given.

In order to provide consent, an individual must:

  • Be of legal age to provide consent to sexual activity or contact (this varies by state).

  • Know and be able to state what he/she wants to do or does not want to do.

  • Individuals who are deemed mentally incompetent and those with certain intellectual disabilities are not able to provide consent.

  • Be aware he/she is providing consent. Any individual impaired by drugs (over-the-counter, prescription, or elicit drugs) and/or alcohol is unable to provide consent.

  • Be conscious and know and understand what is going on around them. Any individual who is not unconscious, blacked out, or asleep is always unable to provide consent.

Important Notes About Consent:

  • Silence should never imply consent. Just because the individual does not say “no” does not mean that he/she is saying yes or implying consent. Further, failure of any individual to “fight back” should never imply consent to sexual activity or contact.

  • Providing consent for one type of sexual activity or contact is not considered “blanket consent” for all types of sexual activity or contact. For example, providing consent for kissing does not mean that consent to touch the individual under his/her clothing or the removal of his/her clothing has been given.

  • Consent is not a one-time question and is an ongoing process. Any individual consenting to sexual activity or contact has the right to change their mind and withdraw their consent at any time, even after the activity or contact has started. Consent must be part of every sexual activity or contact every single time, as consent is not intended to apply to sexual activity or contact in the future.

  • Threatening, forcing, coercing, or manipulating an individual into agreeing to sexual activity or contact is not consent to the activity or contact.




What, exactly, do you do for adults at The Cottage?


What we DO for adults at The Cottage:

  • We provide medical-forensic services to adult sexual assault victims.

  • We provide crisis intervention.

  • We take a medical history and a history of the reported sexual assault.

  • We complete physical examinations.

  • We collect evidence utilizing evidence collection kits (also often referred to as a "rape kit").

  • We photograph any injuries.

  • We utilize special equipment to better visualize the anal and genital areas to help identify and document "micro trauma" in those areas that may not be seen with the naked eye.

  • We offer and provide initial medical care, including testing for sexually transmitted infections (STIs) and pregnancy, STI prophylactic (preventive) treatment, and emergency contraception (prevents pregnancy).

  • We provide referrals for follow-up medical care, mental health, and other services in the community where the patient resides.

  • We provide information on the Georgia Crime Victim’s Compensation Program and assist with filing for benefits through that program, if necessary.

What we DO NOT do for adults at The Cottage:

  • We do not provide care to adult patients without a complaint of sexual assault.

  • We do not provide follow-up or on-going medical care to any adult patients.




Am I required to call the police before I can be seen at The Cottage?


No, you are not required to call the police before you can be seen at The Cottage. You will, however, need to call us in advance so that our staff can ensure they are onsite and ready to assist you. If you are unable to immediately reach us, police investigators have the ability to reach us on a 24/7 basis. You also have the option to leave a message on our voicemail, and we will get back with you as quickly as possible.

Some sexual assault victims are afraid to report what happened to them to the authorities, and the experienced staff at The Cottage will be happy to discuss your rights and options with you. We will also be happy to assist and support you with making a report to the police, if that is what you wish to do. The authorities can come to The Cottage and take your report in our private setting, eliminating any fears that you may have with walking into a police station to make such a report or calling 911 and having them come to your home when you do not have emergent safety or health needs.

IMPORTANT NOTES:

If you have any physical injuries that may require stitches, suspected fractures or dislocations, head injuries, memory loss, you were strangled (or “choked”) within the past 3-4 days, or any other acute, serious, or life-threatening injury or illness, you need be seen in the closest emergency department (ED) immediately. In these situations, you must be evaluated and medically cleared and stable prior to being seen by the medical-forensic provider at The Cottage. Once you are stable and discharged from the ED or hospital, you can be seen at The Cottage for a proper medical-forensic examination (if this was not done in the ED).

Our staff is mandated, by law, to report any suspected or actual crimes against any minor under the age of 18. We are also required to report suspected or reported sexual assault, domestic violence, or physical violence to law enforcement, regardless of the age of the victim.

Under Georgia law, sexual assault victims are not required to cooperate with law enforcement to obtain a FREE forensic-medical examination, and law enforcement agencies are required to store any evidence collected during that examination for a minimum of one (1) year.




If I have been sexually assaulted, am I required to cooperate with the police in order to receive a medical-forensic examination?


No, you are not required to cooperate with the police in order to receive a medical-forensic examination if you believe you were sexually assaulted, and police are not required to “approve” or request such an examination in order for you to have one. Under Georgia law, sexual assault victims are not required to cooperate with law enforcement to obtain a FREE forensic-medical examination, and law enforcement agencies are required to store any evidence collected during that examination for a minimum of one (1) year.

IMPORTANT NOTE: Our staff at The Cottage, however, is mandated by law to report any suspected or actual crimes against any minor under the age of 18. We are also required to report suspected or reported sexual assault, domestic violence, or physical violence to law enforcement, regardless of the age of the victim.




What is a sexual assault medical-forensic examination?


A sexual assault medical-forensic examination is an examination conducted by a medical professional specifically trained to the standard of care for sexual assault patients.

There are 2 components to the medical-forensic examination:

Medical Component: The main objective of the medical component is to provide high-quality, evidence-based medical assessment and care to ensure patient safety and well-being and facilitate healing after a sexual assault. This process may include crisis intervention, taking a medical history, performing a head-to-toe medical examination, sexually transmitted infection (STI) testing and/or treatment, pregnancy testing and/or emergency contraception, and providing additional medical and mental health referrals that sexual assault patients will need to promote healing. It is important to remember that preventative medication for HIV (the virus that causes AIDS) can only be given within 72 hours of the assault, and emergency contraception can only be given within 5 days of the assault; however, potential efficacy of both decreases as time continues to pass within those time-frames. In order to maximize the level of care they receive following a sexual assault, patients should seek medical care immediately from a medical provider specifically trained to provide evidence-based forensic-medical care to sexual assault patients, regardless of whether or not he/she plans to cooperate with law enforcement or have a forensic exam with evidence collection.

Forensic Component: The main objective of the forensic component is to collect and preserve evidence that can be utilized in any criminal case arising from a report to law enforcement. This may include the identification of the alleged perpetrator. Though it is not the proper terminology, some patients may have heard this referred to as collection of a “rape kit.” This process should be undertaken only by a properly trained and qualified medial-forensic examiner as soon as possible (at least within 120 hours or 5 days of the assault), as evidence degradation begins immediately. Further, valuable evidence is lost when the patient showers, takes a bath, douches, washes or brushes his/her hair, brushes his/her teeth, or washes his/her clothing. Though injuries in the genital and anal areas and the oral cavity heal rapidly, the medical-forensic examiner will take photographs and/or video and document of any injuries, or lack thereof. Our examiners at The Cottage utilize a special instrument called a colposcope that provides good lighting and magnification to facilitate the identification and documentation of any “micro injuries” in the genital and/or anal area that may not be visible to the naked eye. Again, these injuries heal very quickly, so the earlier patients present for care, the chances of capturing this evidence increases. Any patient who feels they were “drugged” or were under the influence of alcohol, medication, or elicit drugs should seek care within 12-24 hours, as most of these substances leave the body system quickly. Always remember, time is of the essence!

IMPORTANT NOTES:

1. Sexual assault victims are not required to cooperate with the police in order to receive a medical-forensic examination, and law enforcement officials are not required to “approve” or request such an examination in order for victims to have one. Under Georgia law, sexual assault victims are not required to cooperate with law enforcement to obtain a FREE forensic-medical examination, and law enforcement agencies are required to store any evidence collected during that examination for a minimum of one (1) year. Our staff at The Cottage, however, is mandated by law to report any suspected or actual crimes against any minor under the age of 18. We are also required to report suspected or reported sexual assault, domestic violence, or physical violence to law enforcement, regardless of the age of the victim.

2. Prior written, informed consent of the patient is required to conduct a medical-forensic examination. The patient has the right to withdraw that consent at any point during the examination. Further, the patient has the right to have only the portions of the medical-forensic examination process he/she wishes to have completed; therefore, he/she has a right and maintains that right to refuse any portion of the examination.





 

Richmond Hill, Georgia

Phone: (912) 445-2517

Email: admin@thecottagerh.org

© 2018 The Cottage at Serenity Hill, Inc. & Ingram-Jones & Associates, LLC

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