Supporting children and young people who may have experienced child sexual abuse - clinical pathway: consultation analysis

Consultation on the Clinical Pathway for healthcare professionals working to support children and young people who may have experienced child sexual abuse

Following publication of the draft clinical pathway in May 2019, we held a 12-week consultation using a wide range of methods to capture comments and feedback.

During our consultation, we received 57 responses from a variety of stakeholders, including:

• Aberdeen City Council
• Angus Child Protection Committee
• Angus Council
• Angus Violence Against Women Partnership
• Barnardo’s Scotland
• British Dental Association
• Care Inspectorate
• CELCIS
• Child Protection Committees Scotland
• Children 1^st
• Children and Young People’s Commissioner Scotland
• Children’s Hospices Across Scotland (CHAS)
• Clackmannanshire and Stirling Child Protection Committee
• East Region Managed Clinical Network for Child Protection
• East Renfrewshire Child Protection Committee
• Dumfries and Galloway Child Protection Committee
• Falkirk Child Protection Committee
• Infant, Children and Young People’s Transformational Change Programme Board, NHS Ayrshire and Arran
• Moira Anderson Foundation
• National Day Nurseries Association
• NHS Ayrshire and Arran
• NHS Borders
• NHS Greater Glasgow and Clyde
• NHS Highland
• NHS Lothian
• NHS Tayside
• NSPCC
• Perth and Kinross Council
• Police Scotland
• Rape Crisis Scotland
• Royal College of Paediatrics and Child Health Child Protection Committee
• Scottish Commission for Learning Disability
• Scottish Government Chief Social Worker Advisers
• Scottish Independent Advocacy Alliance
• Shetland Public Protection Committee
• Stirling Council
• Stop it Now! Scotland
• The Independent Care Review
• The Scottish Children’s Reporter Administration (SCRA)
• Wellbeing Scotland

All comments on the draft clinical pathway were presented to representatives of the Chief Medical Officer’s Taskforce for victims of rape and sexual assault (clinical pathways subgroup) in August 2019. Each comment was considered and responded to by the clinical pathways subgroup. Duplicate comments and all comments unrelated to the clinical pathway have been removed. All comments have been anonymised.

According to the Scottish Government’s Citizen Space policy, comments which identify ongoing legal cases, personal identifying names or information, or inflammatory material have been redacted.

This consultation feedback report includes the comments received, together with the clinical pathways subgroup’s response and any subsequent amendments to the clinical pathway.

During the consultation period, we held 5 focus groups with interested stakeholders and staff groups. The comments from these focus groups have been given an ID number and added as individual comments in the consultation report. This is to ensure that each comment given during a focus group is responded to individually.

Summary of responses

Throughout the consultation, respondents welcomed the opportunity to engage with the CMO Taskforce on this piece of work. Overall, respondents highlighted the need for the clinical pathway to reflect the principles of the changing Scottish legislative and policy landscape. The Barnahus model was highlighted as an example of best practice in this area by providing trauma-informed support, putting the child’s rights first, without undue delay. Respondents further noted the principles of holistic, multi-agency and child-centred approaches as taken in the review of the National Child Protection Guidance and the findings of the Independent Care Review. In particular, respondents noted the need for people’s experiences to shape the pathway. Further clarity was sought on the age of the ‘child’, with respondents expressing a preference for the pathway to cover children and young people up to the age of 18 in line with the UN Convention on the Rights of the Child and the changing policy landscape.

Some areas for further review were suggested, namely that the document should be amended to reflect the multi-agency nature of child protection, and in particular that the process a child or young person goes through is often a journey rather than a series of isolated events. Respondents highlighted the need for the pathway to issues inequalities of provision of recovery and support services, including the role of the third sector and community Child and Adolescent Mental Health Services (CAMHS). Additionally, respondents highlighted that the figures contained for the prevalence of child sexual abuse represented reported rates, and expressed a desire for the figures to reflect the healthcare-specific focus of the clinical pathway. There was a further recommendation from respondents that specific provision should be made for disabled children in order to ensure equity of provision.

In both the aims and the context provided in the pathway, respondents welcomed the focus on the provision of trauma-informed support and national consistency. In some areas, concern was expressed about the mechanisms of locally implementing the pathway. Additionally, further information was requested on the relationship between the clinical pathway and a multi-agency child protection response, specifically the role of the Interagency Referral Discussion (IRD).

Respondents noted that the behaviour the perpetrators and the response of agencies to that behaviour could be highlighted. In particular respondents recommended highlighting several key areas of child sexual abuse, namely child sexual exploitation of children over the age of 16; online child sexual abuse; and sexual abuse within the context of wider domestic abuse. Respondents highlighted that situating children’s experiences within this context, and the context of recovery, may help fulfil the aims of the pathway.

Acknowledgements

The CMO Taskforce would like to take this opportunity to thank everyone who responded and provided feedback during the consultation period.