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, from the parent or guardian, as well as a history of why your child or adolescent 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. 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; however, we do work closely with a multidisciplinary team to ensure that all children and families receive the services they need.

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.

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 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.

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 you and your child/adolescent. 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.

In cases of suspected child 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 (but not occurring in the 3-4 days prior to the disclosure) or may have 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 OR any child or young adolescent who has been observed engaging in sexual contact within the previous 72 hours and when no qualified provider is immediately available at The Cottage. 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 5 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.

In cases of suspected child abuse or neglect, 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. Any child or adolescent with acute physical injuries that may require stitches, suspected fractures or dislocations, head injuries, memory loss, reports strangulation within the past 5 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 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 child abuse specialist in a child-friendly environment. 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.

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 child abuse specialist in a child-friendly environment. 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. Child abuse specialists 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 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.

Most pediatric and family practice primary 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 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.

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. We can talk about what he/she shared with you about the incident, along with any concerns he/she 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 their 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.

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) and any required co-payment or deductible - 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.

Families 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, 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 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. 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.

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.

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.

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.

After the examination the medical-forensic provider will discuss any further medical tsting, 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).

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 help them 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.

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 for you and your family.

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

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.