What is a S.A.R.C.?
A one stop centre which will deliver a
comprehensive and coordinated inter-agency
response to all victims of sexual assault and
rape, irrespective of their age, gender, sexual
identity /orientation, ethnicity, or geographical
location.
The Rowan
Sexual Assault Referral Centre (SARC NI)
Nota
Sexual Violence in Pre-Pubertal Children
25.11.15.
Dr Olive Buckley OBE
olive.buckley@northerntrust.hscni.net
The Rowan Team












Service Manager (wte)
Clinical Director & Lead Forensic Medical Officer (0.4)
Consultant Paediatrics (0.4)
Consultant in Genitourinary Medicine (0.2)
Registered (Band 7) Lead Nurse (wte)
Registered Rowan Nurses (Band 5) (2.2)
Administrator(Band 4) (wte)
Administrator (Band 2) (0.5)
Rota of Forensic Medical Officers
Rota of Registered Rowan Nurses (Band 5)
Rota of Consultant Paediatricians
ISVAs – to be developed
50% PSNI 50% Department funding
The Rowan
 The Rowan Team has offered support, advice and direct care to over 1688 individuals
since we went live on 7th May 2013.
 Year 2 saw an increase in referrals by 18%. Year 3 has seen to date, five months in, a
23% increase.
 1330 individuals were referred into the Rowan for support services, with a further 358
individuals seeking support, information and signposting onwards only.
 49% of referrals were received within normal business hours i.e. Monday - Friday 9am 5pm, and 51% out of hours.
 Source of referral: 77% (n=971) came from the police, with 12% (n=156) being made by
the individual affected him/herself; and the remaining 11% (n=134) came from 3rd
parties.
The Rowan
 39% of those referred into the Rowan were children and young people i.e. <18 years;
61% were adults. Sexual violence and sexual abuse affects people across all age
ranges, from infants to the very elderly.
 In relation to gender breakdown: the majority of individuals referred were female
87%; 13% were male.
 4% of individuals identified as BAME. For a number of individuals and families who
have engaged with the service English was their second language (2.4%).
 43% attending The Rowan presented with complex and / or additional needs: living
with chronic and enduring mental ill-health, physical ill-health and/or learning
disabilities.
 8% report of sexual violence related to intimate partner violence.
 75% were reporting acute assaults i.e. an assault which had occurred within 7 days,
usually ≤ 72 hours.
The Rowan
 A number of individuals (n=24) have re-presented to The Rowan with a further and
separate incident of sexual assault.
 Drug-facilitated sexual assault (DFSA) remains low at 5%.
 Individuals and families reporting sexual abuse and sexual violence have come from
across the region, and a small number from outside the jurisdiction.
 The vast majority of victims knew their perpetrator(s).
 The Rowan Sexual Health Clinic: 64% of individuals aged 13+ have attended; 81% of
children and young people (< 13 years) have been brought to their paediatric sexual
health appointments.
Rowan Year 1 Statistics
(May 2013/14)
0-7
8-12 13-17 18-25 26-35 36-45 46-55 56-65 65+
Total
Female
53
13
107
110
67
55
31
5
5
446
Male
18
12
9
8
8
10
4
5
0
74
Total
71
25
116
118
75
65
35
10
5
520
Rowan Year 2 Statistics
May 2014/15
0-7
8-12
13-17
18-25
26-35
36-45
46-55
56-65
65+
Total
Female
61
15
90
120
80
57
34
7
5
469
Male
16
13
6
9
10
5
3
0
0
62
Total
77
28
96
129
90
62
37
7
5
531
Figure 4 Number of Referrals per Trust
Other
BHSCT
NHSCT
SEHSCT
SHSCT
WHSCT
Total
Adults
92
72
45
61
56
3
329
Children &
Adolescents
41
63
35
25
38
0
202
Total
133
135
80
86
94
3
531
Figure 5 Number of Child & Adult Referrals per Trust
Republic of Ireland
Annual report y/e Dec 2014
Cork *SATU: Numbers seen= 103 > 14yr
Mullingar SATU : Numbers seen=85 >14yrs
Donegal SATU: Numbers seen = 40 >14yrs
Rotunda SATU: Numbers seen= 286 > 14yrs
( >14yr service but 8 12-14ys attended)
Galway SATU:
Numbers seen= 48 >14yr
Waterford SATU: Numbers seen =66 > 14yrs
Galway **CASATS :
Numbers seen = 43
Limerick ( HSE mid west sexual assault
advisory group): Numbers seen=19 > 14yrs
*SATU= Sexual Assault Treatment Unit
**CASATS=The Child and Adolescent Sexual Assault Treatment Service
The Rowan Services
 Emotional support;
 Assessment of Hep B risk and rapid immunisation schedule/
immunoglobulin's when indicated
 Assessment for and administration of Emergency Contraception;
 Risk Assessment of HIV, and immediate access to PEPSE (<72 hours
post-assault) to reduce likelihood of contracting HIV (by 80%);
 A Forensic and Medical Assessment by a Forensic Medical Officer (≤ 7
days for forensic swabs);
 For children <13 years, a joint Forensic Medical assessment with a
Consultant Paediatrician;
 Risk Assessment for self harm, vulnerability, and safeguarding;
The Rowan Services cont…
 For those adults who self-refer and have not reported to the Police,
forensic samples can be stored securely for ≤ 7 years to give the
victim an opportunity to consider reporting to the Police;
 Support in meeting with a Police officer from a specialist unit: Public
Protection Unit (PPU) or Rape Crime Unit (RCU) to discuss engaging
with the criminal justice system;
 Rowan Sexual Health Clinic: testing and treatment (where required)
for Sexually Transmitted Infections (STIs);
 Referral into local counseling and support services e.g. Victim Support
NI;
 Referrals into other support / acute services: Emergency Department,
Mental Health Services, Social Services (Gateway / Regional Out of
Hours);
 Liaison with existing support agencies / professionals;
 Follow-up support from the Rowan Team: telephone, face-to-face
contact.
Challenges: Lack of
Disclosure
 80% of victims do not report the offence(s) to the
Police
 72% of sexually abused children do not tell anyone at
time
 1 in 3 victims will never tell ANYONE
National UK Prevalence Study of Child Abuse (Cawson et al, 2000)
Barriers to Disclosure











Fear of perpetrator
Fear of disbelief
Fear of being blamed
Fear for family
No one to tell
Shame/Guilt
Loyalty to Perpetrator
Minimise or not recognise its wrong
Myths and Stereotypes
CSE
Language/ pre-verbal
Challenges:
Managing “No complaint”
The likelihood or otherwise, of a prosecution is NOT the criterion for a joint investigation.
Children who have been the victim of ‘abuse’ will not always support an investigation or want to
proceed through the criminal justice system. This does not remove the responsibility of Police
and Social Services to conduct a thorough, effective and timely investigation”
 Why does a child refuse to support a criminal investigation?
 What happens where a child refuses to support a criminal investigation?

What happens when a child is pre-verbal?
 What happens to children who do not have the capacity and do not really understand the
process and do not engage?
 What about children with capacity, who refuse to engage with police but who agree to forensic
samples being taken so they can decide in future if they want to engage in the criminal
process?
 Are the child's therapeutic needs always considered when there is no engagement with the
CJS?
Examination CSA– why?
 Has alleged act occurred?
 Has any other act occurred?
 Is there medical evidence?
 Is there scientific proof?
 Are there safeguarding issues?
 What are the therapeutic needs?
Challenges: New way of working!
 The challenges and benefits of working together to
implement change
 Improving insight and understanding the roles of
other professionals
 Working with “curious people”
 Reflective Case Study
Role of GP
 GP may identify risk factors for abuse in children/families
and take steps to prevent
 May recognise signs and symptoms opportunistically
 May be asked by agencies to see signs which are possibly
due to abuse but more likely due to other causes
 GP will refer children on to SW/Paediatrician for specialised
assessment
 Sharing of information with agencies
 On-going support for family during process
Role of FMO
 Employed by PSNI
 To look for evidence of abuse by taking a history and examining
the child
 Record Injury and Interpretation of
 Take forensic swabs/photos
 Collection of medico-legal evidence and maintaining a chain
of evidence
 Samples for drug and alcohol from parents/carers
 Prepare a report for PSNI
 Give evidence in Court
Role of Paediatrician
 May identify risk factors for abuse in children/families and take steps to prevent
 May recognise signs and symptoms opportunistically
 On referral will take a history from parents (and child) with consent (from person with
PR)
 Assess/examine the child
 Arrange photographic documentation of any injuries- PSNI/medical photographer or
Paediatrician
 Look for occult injury, disease process/exclude organic causes
 Carry out investigations e.g. blood
 Arrange further medical opinion if required e.g. ophthalmology, orthopaedics,
radiology, dermatology, plastic surgery
 Look for co-morbidity/consequences or sequelae of abuse
 Prepare a medical report for referrer – SW/PSNI or Court
 Assess siblings if required
 Participate in Safeguarding Proceedings/give evidence in Court
 Follow up of child as required
Combined Role of
Paediatrician/FMO
 Assessment and treatment of injuries
Check for Sexually Transmitted Infections
Pregnancy assessment and Emergency
Contraception
Support
Reassurance when appropriate
Opinion
Investigative Role of PSNI
Respond to Incident
Suspect Management
Victim and Witness Management
Forensic Management
PPS Management
Investigation Process
Initial report
Suspect management..
Arrest
Medical examination
Interviews
Evidence
gathering....
Medical
examination of
victim
Victim and witness
interviews;
Scene examination
Written statements
and video recorded
accounts
Premises searches
CCTV checks
House to House
enquiries
Seizure of items for
forensic
examination
Court Process
Case evaluation...
Charge/ Report
Report to Public
Prosecution Service
• Magistrates Court
• Preliminary Enquiry
• Crown Court
• Arraignment
• Trial
Challenges: Strategy
Discussion
Consider:
“Protocol for Joint Investigations by Social Workers
and Police Officers of Alleged and Suspected Cases
of Child Abuse”
AND
“The Rowan Children and Young People Pathway”
Protocol for Joint Investigations by Social Workers and
Police Officers of Alleged and Suspected Cases of Child
Abuse
 1.8 Principles underpinning the Protocol for Joint Investigation (page 8) ‘the
child’s welfare must always be paramount and this overrides all other
considerations’
 2.27 (page 18) ‘The initial strategy discussion/ meeting will always include
Police and Social Services and, as appropriate, may include a Forensic
Medical Officer, GP, Paediatrician …’
 2.30 (page 19) ‘The initial Strategy Discussion/Meeting should address the
following points: …should a forensic medical examination be undertaken
and if so, by whom? Is a joint medical appropriate? If forensic medical
examination is considered necessary form PJI6 must be completed by the
relevant doctor …’
Rowan Children and Young People Pathway
Challenges:
Strategy Discussion
Who should be involved?
Strategy discussion with
SW/PSNI/FMO/Paediatrician-who should
examine, when and where? Joint FMO +
Paediatrician or singly?
Discussion should be with paed consultant not
junior staff
Escalate if don’t agree
Challenges:
Strategy Discussions












Does child need examined? Do we think the unthinkable?
Who and when should examine the child and where?
Do STI tests need to be done now?
Does child need hepatitis B prophylaxis?
Is child at risk of HIV and if so, is PEPSE indicated?
Does young person need emergency contraception?
? CSE
Child and family anxiety
Co-operation of child, aim to see in normal children wakening hours
Should forensic samples be taken from child?
Do forensic samples need to be taken of suspect?
Safeguarding arrangements?
Strategy Discussion:
Who should be examined?
Indications For A Paediatric Forensic Medical Assessment (Rowan) – FMO and
Paediatrician
 Allegation / disclosure
 Witnessed event
 Genital Injuries – unexplained (Urgent)- may need EUA
 Sexually transmitted infections
 Behavioural Disturbance – self-harm, inappropriate sexualised behaviour
 Contact with a sexual offender
 Sibling / friend of another child suspected / confirmed as having been sexually
abused
 Combination of concerns
Strategy Discussion:
Who should examine?
Joint Paediatric Forensic Medical Assessment
(FMO and Paediatrician)




Best Practice Guidelines from RCPCH/ACPO
Consider in all children/young people < 16 years
Rowan Aim - all children < 13 years
Discuss all children 13-18 years with “vulnerability factors”
(Guidelines on Paediatric Forensic Examinations in Relation to Possible Child
Sexual Abuse FFLM, Oct 2012)
Strategy Discussion:
When should examination take place?
 NB: Unexplained genital bleeding needs urgent (same day)
assessment
 Forensic sampling up to 7 days
 Forensic examination up to 21 days for injury assessment
 No time line for historic reporting if h/o genital injuries
 Collection of other forensic material eg nappies, sheets
 Collection of early evidence
 Samples from suspects
 Timing of ABE
 Aim to see in wakening hours ( FFLM guidance)
Challenges:
Myths re Medical Examination
 Lack of understanding regarding what examination
entails (Examination is inspection only i.e.“ no internals, no
speculum”).
Never say: “Don’t want to put the child through it”
 Unrealistic expectation regarding examination
(Examination is only part of the jig-saw. No injury does not mean
no assault)
Never say: “The doctor will tell you what happened and
will be able to tell if the child was abused ”
The Challenge of Criminal Law (NI)
Act 1967
Under Section 5 of the Criminal Law (NI) Act 1967, a person
who has knowledge of and fails to report to the police an
offence that carries a possible punishment of 5 years or
more imprisonment commits an offence punishable by up
to 5 years imprisonment.
http://www.legislation.gov.uk/apni/1967/18/section/5
Challenges:
Children who display sexually
harmful behaviour
 Rowan victims had identified 12% of those who
perpetrated sexual offences as being <18 years.
 Challenges in identifying normal, concerning and
harmful behavior
 Suspects do not attend Rowan for forensic examinations
Galway CASATS
Annual Report 2014
Referrals from counties Galway , Clare , Sligo , Limerick , Westmeath , Kildare ,
Roscommon , Mayo , Tipperary , Offaly




43 (and 5 for follow up)
34 female 7 male
7 months to 20 yrs. Old
Mean age 7.8
 12 were acute





8 cases involved child assailants , 7 were male
13 alleged assailant was father
7 mothers partner
3 stranger
1 mother
Galway CASATS
Annual Report 2014
Of the 8 child assailants:
 4 were under 12yr,
7 were male and 1 female
Age unknown of 2
2 between 13yr and 18yr
Sexual Assault Referral Centre (SARC) Northern Ireland
Thank You