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Treatment and Follow-up : Communicating with Non-Offending Caregivers After Suspected Abuse

When child abuse is suspected, the family dynamics can vary widely. The alleged abuser may be:

  • A parent or caregiver
  • Another family member
  • A friend, acquaintance, or stranger

The non-offending caregiver may respond in many ways, including:

  • Denial of the abuse
  • Guilt, anger, sadness, or depression
  • Support for the child/adolescent
  • Confusion about next steps
  • In many cases, presentation for medical care is a positive indicator that the non-offending caregiver is acting appropriately to seek help.

Goals and Best Practices

Goals During the Medical Encounter

  • Prioritize the child’s medical needs and emotional safety.
  • Support the family as they navigate investigations and treatment.
  • Communicate clearly; families under stress may retain only part of what is shared.
  • Provide written materials on STIs, injury care, follow-up plans, and contacts for additional support.

Best Practices for Engaging with Non-Offending Caregivers

  1. Establish Rapport
    • Build trust early with both the child/adolescent and caregiver.
    • Approach conversations with empathy and openness.
  2. Clarify Your Role
    • Clearly state: “My role is to ensure your child’s health and safety.”
    • Reinforce that their choice to seek care shows they trust you.
  3. Use a Supportive Communication Style
    • Use a neutral, non-confrontational tone.
    • Avoid accusations or speculation about the alleged perpetrator.
    • Frame the encounter as a health evaluation, not a legal investigation. However, identify your role on the multidisciplinary team (if applicable).

Handling Sensitive Conversations

  • When Interviewing the Child/Adolescent
    • When possible, speak to the child/adolescent alone.
    • Let caregivers know this is part of your standard process.
    • If a caregiver refuses, do not force the issue, you are not required to perform a forensic interview.
  • When Explaining Physical Findings
    • If no injuries are found: “It’s very common for there to be no physical signs, even when abuse has occurred.”
    • If injuries are present and abuse is suspected: “These findings raise concerns for abuse. I’m here to advocate for your child’s safety.”
  • When Reporting Is Required
    • Be transparent: “Based on what I’ve seen and heard, I need to report this to Child Protective Services/police.”
    • Emphasize your duty to protect the child, not just follow the law.
    • Offer reassurance: “I’ll continue to support your child and help guide you through the next steps.”
    • Provide contacts and help the caregiver understand what to expect from CPS or law enforcement.
  • If Reporting Might Increase Risk
    • If notifying the caregiver could endanger the child, withholding this information may be appropriate.
    • In most cases, though, aim for open communication.
  • Avoiding Promises
    • Do not guarantee safety or say things will “get better”; investigations are often lengthy and emotionally difficult.
    • Avoid implying that the perpetrator will be arrested or jailed immediately.
    • Be honest about uncertainty: “I can’t predict exactly what will happen, but I’ll do everything I can to support your child.”

Communicating with Non-Offending Caregivers After Suspected Abuse

Treatment and Follow-up