Development of standardized clinical training cases for diagnosis of sexual abuse using a secure telehealth application

Lori D. Frasier, Ioana Thraen, Rich Kaplan, Patricia Goede

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Objectives: The training of physicians, nurse examiners, social workers and other health professional on the evidentiary findings of sexual abuse in children is challenging. Our objective was to develop peer reviewed training cases for medical examiners of child sexual abuse, using a secure web based telehealth application (TeleCAM). Methods: Sixty de-identified cases developed by 2 child abuse pediatricians, were stratified by availability of information (minimal, moderate, comprehensive) for both positive and negative child sexual abuse findings. These cases were narrowed to a set of 30 cases through an expert peer review process using pediatricians with extensive expertise in the evaluation of child sexual abuse. A previously studied secure web-based telehealth application TeleCAM which contains a child abuse workflow, was used to develop, disseminate and review cases. A series of Free Margin agreement statistics are used to select those cases with the highest rates of agreement. A final set of 30 cases are stratified equally by availability of information and for both positive and negative findings. Mantel Haenszel Chi-square was used for trend analysis of the ordered categorical variables. Results: The highest degrees of inter-rater reliability was found in cases with moderate to comprehensive information. Cases with minimal data had poor kappa agreement indicating that availability of differing levels and types of information contribute to variability in diagnostic findings. Conclusion: These final cases will be further studied with medical examiners in various settings utilizing TeleCAM as the application for dissemination.

Original languageEnglish (US)
Pages (from-to)149-155
Number of pages7
JournalChild Abuse and Neglect
Issue number2
StatePublished - Feb 2012

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Developmental and Educational Psychology
  • Psychiatry and Mental health


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