View source for STAR Clinic and Child Abuse Team

==What is the STAR Clinic?==
The STAR Clinic stands for Surviving and Thriving while At Risk. The STAR Clinic is a YKHC Field Clinic located at the Bethel Child Advocacy Center, Irniamta Ikayurvat, which is a CAC based on a national model first developed in Huntsville Alabama in 1985.  At a Children's Advocacy Center, the various members of the child protection, law enforcement, prosecution, victim advocacy, medical and mental health communities are able to provide children and their families comprehensive services within a child-friendly environment designed to meet a child's needs when there are concerns about abuse or neglect.  CACs provide forensic interviews, medical evaluations, mental health services, and referrals for other services as needed. 
 
==Where is the STAR Clinic Located?==
The STAR Clinic has an exam room in Irniamta Ikayurvat, which is in the same building as Tundra Women’s Coalition. 
248 6th Avenue Bethel, AK 99559
Phone 907-543-3444
Fax 907-543-3752
 
==Who sees children at the STAR Clinic?==
Our highly experienced team includes health care providers and Sexual Assault Nurses (SANEs) are specially trained to care for children who may have been physically or sexually abused. We make every effort to serve the needs of children and their families in a relaxed and friendly setting. We are committed to reducing trauma, fostering healing and promoting advocacy on behalf of children in need.
 
==What happens during a typical visit to Star Clinic?==
*Most children come to the CAC by referrals from law enforcement, the Office of Children’s Services (OCS), and medical providers.
*We will make the appropriate report to OCS if this has not already been done.
*We see children for sexual and physical abuse as well as severe neglect and drug endangerment.
*We primarily see children < 18 years of age.  However, we may see developmentally delayed adults if felt to be in the best interest of the patient and requested by the investigator.
===Preconference=== 
*Investigators from the involved agencies, along with a CAC staff member and medical provider from YKHC, meet with non-offending parents or care-givers to discuss the report or concern about the child.  The process is explained, consents are obtained, and a tour of the facility is given.
===Forensic interview===
*The specialized forensic interview is conducted by an investigator from OCS or law enforcement or by a Family Care Coordinator depending on the situation.  All interviewers have had training on talking with children about difficult topics, including the interview format of Child First
*The interview is witnessed by other members of the team who are involved in the case.  The interviewer will break at some point to come ask the team members for suggestions and additional questions that should be asked.  Every attempt is made to minimize duplicative interviewing and questioning of children unless necessary for clarification. 
===Medical exam===
*A medical exam is important to ensure the health and well-being of the child. It will also reassure the child and their family that everything is okay with their body.
*YKHC has developed criteria for offering and performing comprehensive medical evaluations based on national standards. 
*Medical services are provided in our child-friendly examination room. Usually a parent or guardian remains in the room with the child. The medical exam is not painful or invasive. 
*The examination begins with the provider getting a health history from the parent or guardian. 
*A general physical exam is done similar to a well-child visit with their primary care physician.
*If indicated, the examination of the child's genital and anal area is completed. A special system is used during this part of the exam. This system has a light and magnifies the area to allow the provider to see the child's private parts more closely. If needed, photographs may be taken. 
*Cultures may be taken during the exam; this is done with a small cotton swab and is not invasive or painful for the child. 
*After the examination, the medical provider will meet with the family to explain the results of the medical examination and answer questions the family may have. Any questions or concerns the family has may be discussed without the child present. 
*If an exam is not indicated or is refused, a brief medical history and evaluation for other health risks may still be done by the medical provider.
*'''The overarching premise for the medical exam and any forensic or diagnostic testing is FIRST DO NO HARM.  Exams and testing will always be done in a way to minimize any trauma to the child.'''
===Forensic evidence gathering=== 
*The majority of the children we see will not have any forensic evidence on their bodies. This is because: 
**Children often disclose after the window of time in which forensic evidence is likely to be found
**Children are often subjected to types of abuse in which forensic evidence is unlikely to be present on their body
*The decision to gather forensic evidence is made on a case by case basis depending on timing of last exposure, acts described, and findings at the time of the exam
===Labs===
*The majority of prepubertal children we see will not have any STIs.  This is because: 
**Children are often subjected to types of abuse in which transmission of infection is less likely
**There are physiologic differences in prepubertal children that may affect their susceptibility to acquire and/or carry STIs
*The decision to do laboratory testing is made on a case by case basis, depending on the timing of last exposure, acts described, risk factors of the perpetrator, physical symptoms of the child, epidemiologic risks in the child’s home community, and findings at the time of the exam
*Children with physical abuse findings may need diagnostic studies to be sure their injuries are not from a medical condition that mimics abuse
===Medications=== 
*We prescribe antibiotics for STI prophylaxis and Plan B (or equivalent) for pregnancy prophylaxis here at CAC
 
==What else does the Child Abuse Team Do?==
*Provide consults in situation where child abuse is suspected
*Help facilitate reports of child abuse to OCS and Law Enforcement
*Follow-up on reports made to OCS and Law Enforcement (If made aware by reporter)
*Provide chart reviews in situation which child abuse is suspected
*Provide  referrals for medical, dental, and optometry care
*Provide referrals to behavioral health
*Follow-up STAR Clinic Appointments as need, repeat photodocumentation, repeat diagnostic studies
*Chart review of children that might be at high risk for abuse
 
==How to contact the Child Abuse Team?==
*TigerConnect: Child Abuse On-Call Role
*Raven: Communication to the Child Abuse Pool

==To Book an appointment for STAR Clinic==
*''all appointment are made in coordination with the Child Abuse Team.''
*There are times that you may be asked to make an appointment for STAR Clinic. These are often follow-up appointments for child abuse cases. This appointment is necessary in order to have travel arrangements made for these children if they are not being brought to Bethel by OCS or Law Enforcement. 
*To Book an appointment, STAR Clinic can be found in the Ambulatory Bookshelf
**[[image:Ambulatory_Bookshelf.png]]
**Appt. type: Office visit
**Appt. location: STAR clinic
**Reason: If you do not know the reason, you may use SCAN (Suspected Child Abuse/Neglect)

==Resources/References==
* [[SART]]
* [[Strangulation]]
* [[media:Suspected_pediatric_child_abuse.pdf|Suspected Physical Abuse Procedure (Pediatric) YKHC Clinical Guideline]]
* [[media:Suspected_pediatric_sexual_abuse.pdf|Suspected Sexual Abuse Procedure (Pediatric) YKHC Clinical Guideline]]
* [[media:FIRST_Child_Abuse_Response_Guide.pdf|A Guide for Responding to Child Abuse]]