Healthcare professionals - supporting children and young people who may have experienced child sexual abuse: clinical pathway

1 Introduction

1.1 What is the purpose of the guidance?

The purpose of this guidance is to ensure a consistent approach to the provision of healthcare and forensic medical examination services for children and young people of either sex who may have experienced sexual abuse. It is intended to complement existing guidance, standards and legislation and should be read alongside those.

This guidance was first published in November 2020. This version (April 2022) has been updated to take account of the Forensic Medical Services (Victims of Sexual Offences) (Scotland) Act 2021, updated National Guidance for Child Protection in Scotland and plans to incorporate the United Nations Convention on the Rights of the Child into Scots Law. Policy and operational developments relating to Bairns’ Hoose (the Scottish Barnahus model) and Getting it right for every child (GIRFEC) have been incorporated where appropriate.

The pathway covers the journey of care and support for the child or young person, from initial concern through to their onward recovery. It describes the requirement for close working between the NHS, social work services, police, education where appropriate and the third sector to ensure the provision of a holistic healthcare response. It is important to identify potential signs of child sexual exploitation that may be present when following the pathway, and to ensure there is a sharing of information between agencies.^[1]

This clinical pathway will be subject to review to take account of any changes to relevant guidance or legislation. This pathway does not supersede or alter any duties or requirements imposed by legislation or legal obligations and principles arising from case law determined by the courts.

It is important to recognise that it is for a court to decide whether sexual abuse has taken place if there is a prosecution or other proceedings. Healthcare professionals may be cited to give evidence in those proceedings and, if judged to be a skilled witness, may be asked to provide their opinion about the conclusions that can be drawn from their findings.

1.2 Who should use the guidance?

This guidance is for healthcare professionals working to support children and young people who may have experienced sexual abuse. It should also be a key reference document for police, social work services, Child Protection Committees, the third sector and Integration Joint Boards (IJBs) to support the effective planning and delivery of services. It is not prescriptive and is intended to support ongoing improvements to services.

1.3 How should the guidance be used?

The guidance has been designed to enable easy navigation to the appropriate sections. Where possible, footnotes are provided for all resources referenced or referred to in the document.

Anything defined in the guidance is a general description of the term and is not referring to a statutory definition of the term, unless otherwise specified.

1.4 Who is this guidance applicable to?

This guidance is applicable to the care and treatment of children and young people who may have experienced sexual abuse up to their 16^th birthday. Depending on professional judgement it may also apply to young people up to their 18^th birthday where there are vulnerabilities and/or additional support needs where a child protection approach is considered more appropriate than adult support and protection measures.

Appendix A discusses the definitions of children and adults with regard to the relevant legislation and guidance.

The definition of a child in Scotland is dependent on the legal context. Appendix B summarises considerations that are relevant to the clinical pathway and multi-agency assessment and planning for children and young people who may have experienced sexual abuse.

1.5 What other documents should be consulted?

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

• Standards of Service Provision and Quality Indicators for the Paediatric Medical Component of Child Protection Services in Scotland (Child Protection Managed Clinical Networks 2017)^[2]
• Getting it right for every child (GIRFEC)^[3]
• 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)^[4]
• Healthcare and Forensic Medical Services for People who have Experienced Rape, Sexual Assault and Child Sexual Abuse: Children, Young People and Adults Quality Indicators (Healthcare Improvement Scotland 2020)^[5]
• Service specification for the clinical evaluation of children and young people who may have been sexually abused (Royal College of Paediatrics and Child Health)^[6]
• Quality Standards for Clinicians Undertaking Paediatric Sexual Offence Medicine (PSOM) (Faculty of Forensic and Legal Medicine, 2021)^[7]
• Good Practice Service Delivery Standards for the Management of Children Referred for Child Protection Medical Assessments (Royal College of Paediatrics and Child Health, 2020)^[8]
• National Guidance for Child Protection in Scotland (Scottish Government, 2021)^[9]
• Forensic Medical Services (Victims of Sexual Offences) (Scotland) Act 2021
• Self-Referral National Protocol (Scottish Government 2021)
• Spotting the Signs, a national proforma for identifying risk of child sexual exploitation in sexual health services (The British Association for Sexual Health and HIV (BASHH) and Brook, 2014)

1.6 Who has developed the guidance?

Under the remit of the CMO Taskforce, a Clinical Pathways Subgroup was established to develop a national clinical pathway for adults and a national clinical pathway for children and young people. Both pathways have had input from third sector organisations to represent the views of people with lived experience.

A wide range of multi-agency professionals are members of the subgroup including the Child Protection Managed Clinical Network (MCN) managers, paediatricians, Police Scotland, third sector and members of the Scottish Government Child Protection Unit.

Appendix F includes a list of people who were involved in the Children and Young People Pathway Subgroup.

1.7 Review of the pathway

The pathway will be kept under review and will be updated to reflect any changes in the guidance included in this document.

This pathway contains references to legislation that are relevant to forensic medical services. This pathway does not supersede or alter any duties or requirements imposed by legislation or legal obligations and principles arising from case law determined by the courts. Legislation may have been amended before this document is next reviewed and it should not be considered a comprehensive description of the law in this area. Case law may also have changed. If needed, independent advice should be obtained on the accuracy of any references to legislation or reference to any other legal obligations or descriptions of the law. If legal advice is required in relation to the provision of care, this should be sought through the normal Health Board process.

1.8 Background to the pathway

In March 2017, Her Majesty’s Inspectorate of Constabulary in Scotland published a report^[10] which provided a strategic overview of forensic medical services for victims of sexual crime and made a number of recommendations to improve these. The Chief Medical Officer for Scotland was asked by the then Cabinet Secretary for Health and Sport and the Cabinet Secretary for Justice to chair a Taskforce to provide national leadership for the improvement of these services.

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, sexual assault, or child sexual abuse in Scotland.

In December 2017, Healthcare Improvement Scotland (HIS) published National Standards to ensure consistency in approach to the delivery of these services across Scotland. These standards are underpinned by Quality Indicators published in March 2020.

1.9 What terminology is used in the guidance?

Terminology within this document is aligned with Healthcare Improvement Scotland’s National Standards.