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

8 Post-examination care

8.1 Follow up for health needs and other support

Assessment for STI testing including consideration of BBV prophylaxis and pregnancy risk should be undertaken and managed in line with current guidelines and HIS Quality Indicator 5. With consent, this should be communicated to the GP to support onward care. In addition any concerns or disclosures regarding harmful coping strategies, self-harm or suicidal ideation should be appropriately shared with other health professionals^[45].

Rape or sexual assault may place some individuals of reproductive age at risk of unwanted pregnancy. The healthcare professional should assess the need for, offer and provide EC^[46].

Referral for follow up of healthcare or other needs and/or referral to the Reporter can take place throughout the process.^[47] It is best practice to give a brief written summary of findings and outcome as well as a clear list of contacts for follow up at the end of the examination to the child/young person and their non-abusing parent/carer(s).

Children and young people who have suffered sexual abuse and their non-abusing parent/carer(s) should be supported to access any follow up healthcare services or support they may need. The General Practitioner and school nurse have an important role in helping with access to the necessary services.

8.2 Ongoing care to support recovery

As required by HIS Quality Indicator 4 (assessed support needs and ongoing safety planning), every child and young person who has experienced sexual abuse should be offered a trauma-informed and holistic needs assessment to consider whether they and/or their non-abusing parent/carer(s) need support. The needs of each child and young person and non-abusing parent/carer(s) are unique. This may be provided directly by statutory agencies responsible for their care (including NHS Boards) or through a third sector partner, and the process for doing this should be agreed between those local partners. The role of General Practitioners and school nurses as ongoing points of contact may be particularly important in this regard.

For some, the investigation of a report of sexual abuse results in relatively short-term contact with professionals. Others will go on to have a Child’s Plan as part of the GIRFEC process and/or be identified as needing additional support, possibly through the Children’s Hearings System. Others may need particular support during any court proceedings and so may find it helpful to re-engage with support further on as a court case approaches. For further information on GIRFEC, see Appendix E.

Access to trauma-informed support should be in place for every child and young person and their non-abusing parent/carer(s) following sexual abuse. This includes access to mental health services if required. This should be accessible from 0-18 years regardless of age or location. Children and young people and their non-abusing parent/carer(s) should have the ability to access appropriate support in the future, even if they have previously not taken up an offer of support. Acknowledging that support plans are individual, the types of support required usually fall into the following categories:

Immediate Support for Young Person: Children and young people who have disclosed abuse can show signs of distress in a wide range of ways. Many have difficult relationships with their peers, within their family, poor school attendance or difficulty coping in school in general. Some young people put themselves or others at risk of harm.

Immediate support post-disclosure can help children and young people to ‘normalise’ their daily life. Focusing on bringing positive changes to their particular issues – e.g. family relationships, school etc. enables the young person to get back to feeling more in control, more ‘normal’ and generally happier within themselves.

Immediate Support for Families: When children and young people disclose abuse, there is often a need for immediate support to their non-abusing parent/carer(s) to help them consider safety issues. Parents, carers and siblings will normally be the primary source of support to a child or young person following abuse and that much benefit can be gained from direct support of families as these primary carers.

There may also be additional complications when having to deal with the consequences of disclosed abuse within their family. A disclosure of familial sexual abuse is usually devastating for parents and can lead to a crisis within the extended family.

It is not unusual for a young person who discloses either familial or non-familial abuse to find themselves in a family that is at breaking point. Some feel a strong sense of guilt and blame, especially where siblings are affected. Support for a non-abusing parent/carer(s) can help them to support their child(ren), offer guidance and empower them in careful decision making at what is an immensely stressful time. Support mechanisms for families are important, particularly for cases involving younger children.

Medium to Longer Term Recovery Support: Some children, young people and families will need support, to help them to make sense of their experiences and move on positively from sexual abuse. Some need this shortly after disclosure, whilst others find that they need this later in their life e.g. when they enter puberty or begin to have their first intimate relationships. Support to recover from the impact of childhood sexual abuse needs to be available when the young person needs it and for as long as they need it.

Local services must ensure sufficient continuity and coordination of planning and support for each vulnerable young person at risk of harm as they make their individual transitions to adult life and services. ‘Transitions’ may be considered by services to be a ‘handover’ between services, and yet for a young person they are multi-dimensional.

Advocacy Support: A child or young person and their non-abusing parent/carer(s) should be signposted to child advocacy services. Where these services are not available in the local area, then they should be sought from elsewhere and discussions should take place locally about establishing pathways to such services.

A child’s journey following suspected abuse is often hugely complex and confusing, with them needing to move between different agencies and disciplines, telling and re-telling their traumatic experiences. They can be subject to a range of interviews and procedures, in a range of settings, by multiple professionals. Dedicated advocacy support for a child and their family provides a consistent source of information about what is happening and what to expect. In addition, advocacy ensures that the young persons are given the chance to say what they want to happen in decisions that affect them and ensures that families understand the process they are involved in.

Services will vary between areas and may be provided by local authorities, health boards or third sector or a combination of providers. The need for advocacy is particularly important if a case proceeds to court for support to navigate the criminal justice process, e.g. help with providing a statement and attending court, and emotional support during the process. Advocacy services are available for any child referred to a children’s hearing and support is available for any vulnerable witness giving evidence in children’s hearings proceedings.

Co-ordination: A child or young person and their non-abusing parent/carer(s) should have access to someone who will help coordinate their journey through and between services and agencies. Where this support is not available, Health Boards and Local Authorities should work together and with the third sector to ensure provision of a service. The person delivering this role will be a consistent point of contact. They will offer support, accessible information, and co-ordination with more specialist support and advocacy services as appropriate for the child and family as they progress through a range of complex and potentially re-traumatising processes and procedures in their journey following sexual abuse. It is this single, trusted, consistent adult that children and young people most commonly say they need.