Forensic Medical Evaluation of Children Seeking Asylum: A Guide for Pediatricians

Abstract

Applications for asylum in the United States have increased significantly in the past decade, including those by children fleeing persecution. Pediatricians may serve as a resource for children seeking asylum by participating in specialized training and performing forensic medical evaluations for use in the legal process. A forensic medical evaluation comprises an interview to elicit a narrative of reported abuse, a psychological assessment, and/or a medical assessment. Evaluators document an impression of the consistency of medical and psychological findings with the trauma, which forms the legal basis for a child's asylum claim. This article provides guidance to pediatrician evaluators with an emphasis on an age- and development-specific approach to a forensic medical evaluation of children seeking asylum. Collaboration with primary care pediatricians and community partners about asylum evaluations is important to building support for immigrant children who have experienced trauma. [ Pediatr Ann . 2020;49(5):e215–e221.]

Characteristics and scope of humanitarian relief forensic medical evaluations for immigrant children in the US

“…Recently, standards and best practices for adult evaluations and a guide for pediatric asylum evaluations have been published. 6,17 However, most asylum evaluation training programs-including the programs reported by respondents such as Physicians for Human Rights and HealthRight International-are not pediatric-specific, highlighting a need to institute such training. Training curricula need to address pediatric developmental stages and their impact on clinical manifestations of traumatic stress.…”

“…Training curricula need to address pediatric developmental stages and their impact on clinical manifestations of traumatic stress. 17 Curricula and training also are needed to ensure that principles of trauma-informed care are followed to minimize re-traumatization and to ensure children's safety and well-being. 17,18 Thus, there are opportunities for future directions in this field related to training, collaboration, advocacy, and research, which we discuss below and summarized in Table 3.…”

A Decade’s Experience Performing Forensic Medical and Psychologic Evaluations for Pediatric Asylum Seekers in the United States

“…Forensic medical and psychological evaluations by health professionals that corroborate claims of persecution increase an individual's likelihood of being granted asylum [7][8][9][10][11][12][13]. During these evaluations, health professionals assess the individual's overall health and identify signs and symptoms of human rights abuse, and then summarize this evidence in an affidavit to be used in Most of these resources focus on adults but recent preliminary efforts have been made to develop specific guidance on conducting forensic evaluations for children [20,21]. However, there is a need for more involvement from the limited medical community involved in this work, as there is lack of consensus on issues such as the impact of trauma on pediatric development and best practices for minimizing re-traumatization of children during the evaluation process [22].…”

“…Most of these resources focus on adults but recent preliminary efforts have been made to develop specific guidance on conducting forensic evaluations for children [20, 21]. However, there is a need for more involvement from the limited medical community involved in this work, as there is lack of consensus on issues such as the impact of trauma on pediatric development and best practices for minimizing re-traumatization of children during the evaluation process [22].…”