Equally Safe consultation: analysis of responses

5. Provisions for children and young people

Introduction

5.1. The consultation document describes the Scottish Government’s ambition to make Scotland the best place for children in which to live and grow up. It outlines existing research, approaches, standards, frameworks and legislation that explore and underpin respect and protection for children and young people within the context of forensic medical services. These include: 

• The National Guidance for Child Protection in Scotland and Guidance for Health Professionals in Scotland
• Getting it Right for Every Child (GIRFEC) 
• The UN Convention on the Rights of the Child (UNCRC)
• An explanation of the Barnahus model, which seeks to provide a trauma-informed response to child victims and witnesses of serious and traumatic crimes in a familiar and non-threatening setting
• The Vulnerable Witnesses (Criminal Evidence) (Scotland) Bill (now an Act)
• The Age of Legal Capacity (Scotland) Act 1991

Responses to question seven: special provisions for children and young people

5.2. Respondents were invited to express views on special provisions within the legislation for children and young people, by responding to the following question:

Question 7: Should special provisions be included in legislation to reflect the distinct position and needs of children and young people? Do you have any views on how such special provisions should operate?  

5.3. A quantitative overview of responses to this question is provided below:

• 79% (42 out of 53) selected ‘yes’ 
• 2% (1 out of 53) selected ‘don’t know’
• 19% (10 out of 53) did not answer the question

Overview

5.4. This question generated comments from three-quarters of the consultation respondents (40 out of 53).  A range of views were identified in these responses. Almost all advocated for special provisions and gave some detail about what these could be, either echoing proposals put forward in the consultation document or describing other matters for consideration by the Scottish Government. 

Provisions for children and young people

5.5. Eleven respondents explicitly expressed support for the implementation of a Barnahus Model as a means of providing special provisions for children and young people. Eight of these left general comments of support; three explained the nature of the Barnahus Model and its key principles, while reiterating that it would be an appropriate model to implement in Scotland.  

5.6. Seven respondents discussed the importance of on-going support for children and young people without providing detail about what this would mean in practice. Another provided a detailed response with a range of recommendations for implementation which have been signposted to the SG for consideration.  This included discussion of six essential features of a child’s pathway following sexual abuse.

5.7. Five respondents discussed facilities, suggesting that legislation should specify that examinations would be carried out in suitable facilities for age and developmental stage of children and young people. Within this discussion, two respondents emphasised that this should not be in police settings.

5.8. Four called for greater provision of advocacy services for children and young people.

5.9. Additional comments made by one or two respondents are summarised in Appendix 4.

Age-appropriate support

5.10. Nine respondents suggested that there should be special provisions for adolescents (ages 13-16) who may not receive appropriate FMS from children’s or adult’s services. Eight respondents discussed the need for appropriate support throughout the examination process, suggesting that FMS staff should be trained in providing age appropriate support. In this discussion two suggested the implementation of the ‘Gillick competence’, the principle used to judge capacity in children to consent to medical treatment.

5.11. Two further singular responses are listed in Appendix 4.

Vulnerable groups 

5.12. Six respondents discussed vulnerable groups in response to the distinct position of children and young people. All suggested that there should be specific provisions for vulnerable groups of children and young people, such as those with additional support needs, disabilities or profound and multiple learning disabilities (PMLDs). 

5.13. Two of this group called for additional support and information for those groups e.g. accessible information, including information about data ownership, consideration of support, assessment of capacity, communication and training for professionals.

5.14. Another expressed concern that there was no dedicated chapter in the consultation for vulnerable groups.  They called for the SG to consider the CRPD^[6] as this equally applies to children and young persons. They also suggest consideration of provisions of both the Vulnerable Witnesses (Criminal Evidence) (Scotland) Bill and the Age of Criminal Responsibility (Scotland) Bill, both of which are now Acts of the Scottish Parliament.

LGBTI community 

5.15. Five respondents reflected on provisions for LGBTI children and young people. One respondent suggested that those who are transgender, non-binary and intersex may not feel comfortable receiving FMS due to discomfort revealing their physical sex characteristics. They believe the right to choose the sex of the practitioner should extend to children and young people, calling for the pathway to reflect the additional impacts of abuse on LGBTI children and young people. This respondent described actions to reduce barriers to reporting, seeking support and accessing health services after experiencing sexual violence.

Self-referral 

5.16. Four respondents reflected on self-referral routes for children and young people. Three noted that they did not think self-referral to police would be possible for those under 16 years, reflecting child protection guidelines and legislation. The other said: ‘We would consider that people [age] 13 and over be afforded access to self-referral without the automatic requirement for information to be shared with police, but appreciate that this may be out of scope’.

A sample of illustrative quotes that typify the themes identified in this section:

“Children and young people should receive services from staff trained in supporting and caring for people of their age group. The environment that examinations and wider treatment and care take place in should be child friendly designed to reduce the trauma experienced. All information provided should be cognisant of the age of the child or young person receiving treatment and care.” (Individual, anonymous)

“Yes, children and vulnerable adults have different requirements and require different support needs.  Information should be understandable to all, appointed representatives to support and guide through the process, and a knowledge of the ownership.” (Individual, anonymous)

“We would strongly urge the Scottish Government to develop specific provision reflecting children’s distinct needs, to create a legislative framework which will underpin the government’s principle policy objective of a recovery focussed service response.  In order to do this, provision must reflect the imperative of a jointly planned, multi-agency response to children and young people, of which the forensic medical examination is just one aspect. (NSPCC Scotland)

“A key issue for consideration in working across both child and adult pathways is the area of ‘Gillick competence’ and ensuring there is support, guidance and training available in this area across both the child and adult workforce.” (Organisation, anonymous)

“Fully supportive of the development of the Barnahus concept to ensure that facilities preserve the rights and dignity of any child.  In addition, special provisions should be made to ensure that there are age appropriate services for adolescents. Adolescents as a group have a distinct set of needs that are not automatically met in adult settings. Adolescents should for example be able to state a preference for facility and that there should be service standards established specifically for adolescents that can be used in adult as well as children’s services.  There is a distinct lack of after care and psychological services for adults, children and young people and it is fundamentally important that there is access to continued care and support and that this forms part of legislation.” (Glasgow Violence Against Women Partnership)

Responses to question eight: potential impact on children and young people

5.17. Respondents were invited to express views on potential impacts for children and young people, by responding to the following question:

Question 8: More generally, do you have any views on potential impacts of the proposals in the chapters of this paper on children and young people including their human rights or wellbeing?   

5.18. A quantitative overview of responses to this question is provided below:

• 38% (20 out of 53) selected ‘yes’. 
• 21% (11 out of 53) selected ‘no’, indicating they had no views to share
• 6% (3 out of 53) selected ‘don’t know’
• 36% (19 out of 53) did not answer the question

Overview

5.19. Thirty respondents shared their views on the potential impacts, some with an additional suggestion(s), example(s) or issue for the Scottish Government to consider.

• Fourteen of these responses reiterated their support for the inclusion of special provisions for children and young people as described in the discussion of responses to question 7.  For reference, themes in responses to question 7 included: implementation of a Barnahus model, provision of age-appropriate support, meeting the needs of vulnerable groups and LGBTI young people and self-referral considerations. 
• The remaining 16 responses form the basis of analysis in this chapter.

Specific issues 

5.20. Eight respondents noted specific considerations to reflect on in relation to children and young people. 

• Two respondents described delays for children and young people in accessing support from paediatricians in suitable examination facilities.  One suggested a legislative duty on health boards to ensure forensic paediatric availability would prevent children and young people being adversely impacted by such delays; the other suggested recommended standards should be enshrined in legislation. 
• One respondent suggested that a multi-agency support model is best equipped to ensure all children’s right to recover from sexual abuse. 
• One described issues around privacy and confidentiality, explaining that this is a challenge when there is a need for the presence of a guardian and might prohibit the victim seeking FMS or support. 
• Another noted that children and young people represent some of the most vulnerable groups, and that it is imperative to provide support to meet those needs. They also discuss that people in this group of victims may experience some of the longest lasting effects of sexual abuse and trauma and that any legislation should consider this. 
• Another respondent noted that any decision to undertake forensic medical examinations must be in relation to the best interest of a child or young person; not the justice system. 
• One noted that a child's developmental stage and ability to disclose and engage with the medical assessment should be assessed.
• Another said that boards need to be adequately resourced to meet all their requirements.

National guidance and policies

5.21. Seven respondents discussed the need to uphold child protection guidance, often referencing the implementation of GIRFEC principles as a way to support children and young people. Three respondents endorsed the reference in the consultation document to embedding GIRFEC principles.  Additional singular comments are detailed in Appendix 4.

Other themes

5.22. Two reflected on children and young peoples’ experiences in relation to justice. One stated that children and young people should not be presented with the trauma of having to face an abuser. Another suggested that giving pre-recorded evidence would benefit the wellbeing of children and young people.

5.23. Another welcomed the increased access to healthcare but suggested that ‘service responses should be carefully considered regarding inter familial violence and protection’.

5.24. One respondent reflected on issues facing young people from conservative cultural or religious backgrounds. They discussed consent and confidentiality implications, noting that the obligation to have a guardian present may cause danger to the children or young people in relation to family honour. This respondent also raised the importance of having wider choice in the examiner; for example, if they were concerned about a potential lack of confidentiality within their minority ethnic community, they would feel more comfortable being examined by someone from a different ethnic background. 

A sample of illustrative quotes that typify the themes identified in this section:

“The proposals recognise the rights of children and young people and I feel will ensure consistent standards of service are delivered with full regard to the well-being and rights of children and young people.” (Individual, anonymous)

“The child’s views should always be taken into consideration and as stated above children should have an advocate to assist them through the process.” (Organisation, anonymous)

“Children and young people are amongst the most vulnerable people in our society – they struggle to be heard and even more so when they have a disability or the younger they are. It is therefore essential that the service they require is suitably responsive to their needs.” The Royal College of Paediatrics and Child Health (RCPCH)