Clinical pathway for children and young people who have disclosed sexual abuse: consultation

1. Introduction

1.1 What is the purpose of this resource?

This pathway is a resource to outline the process for the healthcare response to disclosures by children and young people of sexual abuse of any kind.

1.2 Who should use this resource?

This clinical pathway and guidance is for healthcare professionals in Scotland working to support children and young people who disclose sexual abuse.

This guidance should also be used by NHS Boards, Local Authorities and Integrated Joint Boards (IJBs) to inform the way in which services are delivered and structured locally. It in no way constrains NHS, Police Scotland, or associated partnerships should they wish to enhance the model with innovative elements of service delivery.

Statutory responsibility for forensic medical services currently rests with Scottish Police Authority; however the delivery of healthcare services sits with NHS Boards.

1.3 How should this resource be used?

It is not intended for this resource to be read from cover to cover, rather, this resource is split into a number of chapters for easy access. Where possible, for all resources referenced or referred to within this document, a hyperlink is provided.

1.4 Who is this guidance applicable to?

This guidance is applicable to the care of children and young people less than 16 years of age (or up to 18 years of age for young people with vulnerabilities and additional support needs), who have disclosed sexual abuse of any kind (Child Protection Guidance for Health Professionals)

The definition of a child in Scotland is dependent on the legal context (Sexual Offences (Scotland) Act 2009). Clinicians and others working with those under 18 years old have a responsibility to assess and respond to the circumstances of the individual child or young person and provide an appropriate service.

1.5 What other documents should be consulted?

The guidance is intended to supplement but does not replace existing national guidance and standards such as:

• National Guidance for Child Protection in Scotland (Scottish Government 2014)
• Child Protection Guidance for Health Professionals (Scottish Government 2012)
• Standards of Service Provision and Quality Indicators for the Paediatric Medical Component of Child Protection Services in Scotland (Child Protection Managed Clinical Networks 2017)
• Getting it Right for Every Child (GIRFEC) (Scottish Government 2017)
• Healthcare and Forensic Medical Services for People who have Experienced Rape, Sexual Assault or Child Sexual Abuse: Children, Young People and Adults Standards (Healthcare Improvement Scotland 2017)
• Healthcare and Forensic Medical Services for People to have Experienced Rape, Sexual Assault and Child Sexual Abuse: Children, Young People and Adults Indicators (Interim) (Healthcare Improvement Scotland 2018)
• Service specification for the clinical evaluation of children and young people who may have been sexually abused (Royal College of Paediatrics and Child Health) (the website address is provided in the resources)
• Faculty for Forensic and Legal Medicine (FFLM Guidance) (Royal College of Paediatrics and Child Health) (the website address is provided in the resources)

1.6 Background of the work

In March 2017, Her Majesty’s Inspectorate of Constabulary in Scotland published a report which provided a strategic overview of forensic medical and healthcare services for victims of sexual crime. The report made a number of recommendations. The Chief Medical Officer for Scotland was asked by the former Cabinet Secretaries for Health and Justice to chair a Taskforce which will provide national leadership and oversight in order to help improve service provision in this area.

The Taskforce vision is for consistent, person centred, trauma informed healthcare and forensic medical services and access to recovery for anyone who has experienced rape or sexual assault in Scotland.

A considerable amount of work is being progressed to deliver this vision, as set out in the Taskforce five year high level work plan published in October 2017. Healthcare Improvement Scotland (HIS) has now published National Standards to help ensure a consistency in approach across Scotland as well as Interim Quality Indicators to underpin these.

In parallel, a Clinical Pathways Subgroup was established, including a multi-agency team of experts, to develop national clinical pathways for adults, children and young people that are informed by the views of people with lived experience.

1.7 Who has the developed the guidance?

The guidance has been developed by professionals within the Child Protection Managed Clinical Networks (MCN) Consultant Paediatricians and members of the Chief Medical Officer’s Taskforce for the Improvement of Services for Victims of Rape and Sexual Assault.

MCNs for children and young people were set up in the South-East in 2009, West in 2004 and North in 2015. Their aim is to raise standards, promote the delivery of consistency of approach and outcomes, provide peer support and drive collaborative working and clinical excellence across Scotland.

This guidance is intended to support implementation of the outcomes of the Options Appraisal of the Taskforce (Honouring the Lived Experience). A subgroup of the Taskforce, The Children and Young People Expert Group, has provided advice on tailoring the recommendations of the options appraisal to children and young people. These recommendations are intended to be in line with the Barnahus concept.

1.8 What terminology is used in the resource?

Terminology within this document aligns with Healthcare Improvement Scotland’s Standards for Healthcare and Forensic Medical Services for People who have experienced Rape, Sexual Assault or Child Sexual Abuse: Children, Young People and Adults (Healthcare Improvement Scotland 2017).