P3.215: Slipping Through the Cracks: Recognizing Abuse and Implementing Safety Protocols for Vulnerable Adolescents

Introduction: Children’s hospitals are expanding nationally to treat persons up to 21 years of age. Providers must now navigate adolescents’ right to autonomy while recognizing their risk of abuse as young adults.

Case Description: Our patient is a 19-year-old female who presented to the Pediatric Emergency Department (ED) with witnessed generalized tonic-clonic seizures. Neurology was consulted and determined the seizure activity was non-epileptic via EEG and she was diagnosed with Psychogenic Non-epileptic Seizures (PNES). Urinalysis was ordered per the standard workup for first-time seizure and revealed trichomonas infection. After obtaining patient consent, a complete STI (sexually transmitted infection) panel was collected. Testing demonstrated: Positive treponemal antibody, reflex RPR 1:512, and negative HIV, urine gonorrhea and urine chlamydia. Treatment was initiated for the identified STIs. Upon discussion with the patient, she disclosed recent immigration from Jamaica without significant familial supports as well as uninsured and unhoused status. She also revealed recently engaging in non-consensual sex. It was unclear if there was exchange of goods, protection, or housing provided. Social work was consulted for uninsured status and psychiatry was consulted for PNES. Despite the suspicion for sexual abuse and questionable trafficking, child protective services (CPS) were not consulted due to her age.

Discussion: Adolescent women, aged 16-19, are 4x more likely to experience sexual violence than women of other ages.1 Current laws and institutional practices for mandatory reporting are tailored toward persons < 18 years of age despite older adolescents being similarly vulnerable to exploitation. Data also suggests debilitating sequelae arising in adulthood secondary to inappropriately addressed childhood sexual abuse.1 As children’s hospitals expand care for more complex patients, including adolescent and emerging adults, there is a responsibility to create structures that address abuse for all.2 There is significant literature on the unique approach to caring for emerging adults in pediatric settings and their healthcare transition needs.3,4 However, per our review, we did not find medical literature or guidelines for the utilization of CPS when caring for individuals >18.

Conclusion: In Rhode Island, reporting mandates are specific to persons < 18 or < 21 if currently in CPS custody. This case study hopes to illuminate the widening gaps in literature and protocols for vulnerable adolescents >18 years old experiencing sexual or physical trauma.

1. Banvard-Fox C, Linger M, Paulson DJ, Cottrell L, Davidov DM. Sexual Assault in Adolescents. Prim Care: Clinics in Office Practice. 2020 Jun;47(2):331-349.
2. Brown CM, et al. Trends in Length of Stay and readmissions in children’s hospitals. Hospital Pediatrics. (2020)554-562.
3. Needle JS, et al. Considerations in Caring for Adult Patients in the Pediatric Intensive Care Unit. J Pediatric Int Care. 2016;6(2):77-82.
4. Brown CM, et al. Trends in Length of Stay and readmissions in children’s hospitals. Hospital Pediatrics.