P3.126: Forensic evaluations for asylum-seeking children: A systematic review of practices, lessons learned, and guidance gaps

Background: Each year, tens of thousands of children seek asylum in the United States, often bearing physical and psychological evidence of abuse and persecution. Forensic medical and psychological evaluations play a critical role in corroborating asylum claims and increase an individual’s chance of being granted asylum. While guidance for such evaluations exists for adults, pediatric protocols remain limited and inconsistent. This systematic review synthesizes available evidence on the practice of forensic evaluations with children seeking asylum, aiming to identify best practices and gaps in current guidelines.

Methods: We conducted a systematic review of the literature across seven databases (PubMed, EMBASE, Cochrane, CINAHL, PsychInfo, Web of Science, and Google Scholar) published from 1990 to September 2024. We included studies focusing on forensic medical and/or psychological evaluations of asylum-seeking children ( < 18 years), describing their methods, ethical considerations, or lessons learned. Studies were screened independently in duplicate, with disagreements resolved by consensus. Data was extracted across predefined domains—including training/preparation, clinical interviews, laboratory/imaging methods, affidavit preparation, and oral testimony—identified from existing guidelines (i.e., the United Nations’ Istanbul Protocol and the Physicians for Human Rights’ Examining Asylum Seekers). A narrative synthesis was then conducted.

Results: Out of 11,359 studies screened, 71 met inclusion criteria, including meta-analyses, reviews, randomized controlled trials, cohort studies, and commentaries. Studies spanned the United States, Europe (e.g., Italy, Germany, Sweden), Turkey, Hong Kong, and Malaysia. A large portion of the literature focused on age determination, particularly in European settings where a combination of clinical interviews, dental imaging, and skeletal X-rays are commonly used. However, these methods lack standardization and validation, raising significant ethical concerns around accuracy and potential violations of children's privacy and rights. Regarding medical and psychological evaluations, a limited number of studies discussed training or preparation specific to pediatric forensic evaluations, highlighting a potential gap in evaluator readiness. Many studies emphasized the importance of trauma-informed, child-centered, developmentally appropriate, and culturally sensitive clinical interviews, though few provided structured tools or checklists. Documentation practices, including how children’s narratives were reflected in affidavits or oral testimony, were infrequently described. Numerous knowledge gaps emerged, including those related to appropriate approaches for age and trauma assessment, the use of child-centered interviewing techniques, and strategies to support evaluators in this complex work.

Conclusion: This review reveals substantial gaps in the evidence of best practices for forensic medical and psychological evaluations of asylum-seeking children. Although existing frameworks provide a foundation, there are still many questions regarding ethical, standardized, and child-centered practice. Filling these gaps and developing pediatric-specific guidelines for conducting forensic evaluations is essential to protect children’s rights and ensure high-quality forensic evaluations in asylum contexts.