70 | AUGUST 31 • 2023 PROTECTING YOUNG ATHLETES continued from page 68 them feel uncomfortable should not be kept secret from their parents or legal guardians,” and parents should encourage open communication, without shame or judgment, especially if the young person has experienced something of concern. “Starting at a young age, talk about correct boundaries but don’t overdo it. Boys and girls need to know that no one has a right to touch them. Also, that no adult can ask them to keep a secret,” said Paul C. Jacobs, Ph.D., a licensed psychol- ogist in Bingham Farms. Warning signs of sexual abuse or other harmful experiences include reluctance to participate in activities children previously enjoyed, nightmares or anxiety of any type. “If you notice any abrupt change in behavior, try to gently explore it,” he said, sug- gesting parents ask questions to learn whether their child is simply bored or worried or afraid of someone or some- thing. “Do not ever pressure them for participation; reas- sure them it’s okay if they are reluctant to engage and if they do not want to talk, do not put pressure on them.” Jacobs added that parents can ask if they would like to talk to someone else such as a therapist or another trusted adult. “The more parents are open to discussing things with their children, the more likely kids are to go to their parents if something is wrong,” said Lee Weinstein, M.D., a pediatrician at Child Health Associates in Troy and Novi. He encourages parents to talk to their chil- dren about difficult subjects such as sex, drugs and internet safety. While there are no hard and fast rules, Weinstein says par- ents typically do not stay in the exam room once an adolescent reaches puberty. “If kids want their parents in the room, they can stay; it’s a judgment call,” he said. “Puberty brings a lot of psychological and physical changes, so it can be good for kids to take responsibility and talk without their parents pres- ent. It also gives me an oppor- tunity to ask how things are going socially and at home.” In addition, Weinstein’s prac- tice gives teens pre-appoint- ment screening evaluations for depression, anxiety and other mental health issues. If there are concerns, physicians will talk to the patients and determine whether a referral to another professional or other type of follow-up is needed. Weinstein, whose patients are primarily male, says a nurse is not usually present during routine appointments unless a patient requests it or there are specific issues requiring more detailed examination. He also provides an opportunity to talk privately with a patient whose parent remains in the room during an exam. Finally, Cohen stresses that parents should report suspi- cious behavior directly, not rely on another organization to follow up. While teachers, counselors, coaches and others are obligated by law to report suspected child abuse, includ- ing sexual abuse, to police, this is not always done correctly or in a timely manner. She adds that a failure by caregiv- ers to respond appropriately to young victims can lead to Post Traumatic Stress Disorder (PTSD). If sexual abuse has occurred or is suspected, parents should call the police department where the incident occurred, says Sarah Greene, Acting Chief of the Special Victims Unit (SVU) of the Oakland County Prosecutor’s Office. If the exact location is unclear, call the police department serving the municipality where you live. While many people are reluctant to report suspected abuse without definitive proof, evidence is not required to start the process. “ A victim’s account of what happened is enough to initiate an investigation and pursue criminal charges,” said Greene. After an assault is reported, police will begin an investiga- tion, which typically includes a session with forensically trained child interviewers at an accred- ited child advocacy center such as Care House in Oakland County. Police will then send the information to the prose- cutor’s office to determine the next course of action. “For a variety of reasons, sex- ual assault is an underreported crime. Victims are embar- rassed, ashamed or reluctant to get the person in trouble,” says West Bloomfield Police Chief Michael Patton, adding that some are unsure whether they were actually abused. “It’s an unknown and scary thing when you think some- thing could have happened to your child, or to you,” said Greene. “We’ve started wrapping our brains around the concept of delayed disclo- sures, and the more our community understands, this goes a long way toward encour- aging reporting.” Patton added: “It’s a very difficult experience, but we do what we can to make it easier. It may be better to report a crime as soon as possible, but justice can be served long after the fact.” Tips for Parents 1. Explain to children what kind of touching by an adult is okay and what is not okay. Communicate that they do not have to allow someone to hug them. Encourage them to tell parents if a doc- tor or another adult is doing something that makes them uncomfortable. 2. For children and teenag- ers, request that a parent/ guardian or nurse be present during a medical exam. When teenagers have gynecologic exams, a local gynecologist requires that the patient’s mother is present for the first examination and then a nurse is in the room for subsequent exams. College athletes can ask that an athletic trainer or coach be present during a medical examination. 3. If college athletes are uncomfortable with a physi- cian or other health provid- er’s behavior during an exam, universities provide a process for filing a report/complaint under Title IX, a federal law that prohibits discrimination and sexual abuse at educa- tional facilities that received federal funding. (Public uni- versities are an example of such institutions). 4. If a child or teen says they have been sexually abused, report it immediate- ly to local law enforcement. Dr. Paul C. Jacobs Dr. Lee Weinstein Michael Patton