Sub Regional Child Sexual
Abuse Conference
3rd July 2012
Domestic Arrangements
• Fire alarm - evacuate the building by the nearest
fire exit and assemble in the red car park in front
of the main entrance
• Toilets – through the double doors, on the right
• No smoking in the building
• Please switch off mobile phones
• Do not leave valuables unattended
Child Sexual Abuse
Dr Penny Garrood
Dr Kim Barrett
Level 3 Multi-Agency Training
3rd July 2012
House keeping
Confidentiality
If you feel distressed feel free to leave
Mobile phones / bleeps
Aims
• Signs & symptoms of CSA
• The importance of considering CSA when
children/ YP present to professionals
• The role of health within a multiagency
assessment
• To understand what a full paediatric
assessment involves
• Referral pathway for children/YP who may
have been sexually abused
If you don’t consider it you
won’t spot it
If you don’t consider it you
can’t protect the child
CSA – Working Together 2010
definition
• Sexual abuse involves forcing or enticing a child or young
person to take part in sexual activities, not necessarily
involving a high level of violence, whether or not the child is
aware of what is happening.
CSA includes:
– sexual touching of any part of the body, clothed or unclothed, including
using an object
– all penetrative sex, including penetration of the mouth with an object or
part of the body
– encouraging a child to engage in sexual activity, including sexual acts
with someone else, or making a child strip or masturbate
– intentionally engaging in sexual activity in front of a child or not taking
proper measures to prevent a child being exposed to sexual activity by
others
– meeting a child following sexual 'grooming', or preparation, with the
intention of abusing them
– taking, making, permitting to take, distributing, showing or advertising
indecent images of children
– paying for the sexual services of a child or encouraging them into
prostitution or pornography
– showing a child images of sexual activity including photographs, videos
or via webcams
Child Sexual
Exploitation
• Always abusive
• Children and young people being forced or manipulated
into sexual activity
• Sexual activity in exchange for something:
– money, gifts or accommodation
– affection or status
• Often misunderstood and viewed as consensual
• Violence and coercion common
• Imbalance of power – social, economic, emotional
vulnerability
Age-appropriate sexual behaviour
– Use childish “sexual” language to describe
body parts
– Ask how babies are made/come from
– Touch or rub their own genitals
– Show and look at private parts
– Ask questions about periods, pregnancy, sex
– Compare genitals
– Masturbate in private
– More likely to use sexualised language and
discuss sex
P
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e
s
c
h
o
o
l
S
c
h
o
o
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Children rarely
• Discuss sexual acts/ use sexually
explicit language
• “F**K off” ? Common parlance
• Have physical sexual contact
(penetrative acts) with other children
• Show adult-like sexual behaviour or
specific knowledge of sexual matters
• Masturbate in public
A
g
e
Signs that may suggest CSA
• Public masturbation
• Sexualised language inappropriate for developmental age
• Change in behaviour: withdrawn/secretive or
aggressive/defiant
• New onset wetting and soiling
• Unusual play
• Unusual pictures
• Genital discharge
• Genital warts
• STIs
• Pregnancy
• Disclosure
• Police/SC intelligence
Health Assessment: Why?
• Early discussion with health ensures
timely prioritisation of case
• Protecting the child’s health
• Reassuring the child that they are whole
and not “damaged goods”
• Gaining evidence for investigation by SC
or Police
Parental responsibility (PR)
The Children Act 1989:
• Mother
• Both birth parents if married to each other at the time of
conception or birth, or the couple subsequently marry
• If unmarried, the father may acquire PR via a court order
or a parental responsibility agreement OR is on the
birth certificate since December 2003
• Legally-appointed guardian or special guardianship or
adopted
• a person holding a court-awarded residence order
• a local authority designated in a care order in respect of
the child (NOT under Section 20 of the Children Act - in
‘voluntary care’)
• a local authority who holds an emergency protection
order (EPO) in respect of the child
Competency to consent
• Does the young person understand in simple language what the
medical assessment is, its purpose and nature and why it is being
proposed?
• Understand its principal benefits, risks and alternatives?
• Understand in broad terms what will be the consequences of receiving
and not receiving the proposed assessment?
• Can the young person retain the information for long enough to use it
and weigh it in the balance in order to arrive at a decision?
THINK:
Coercion/ power imbalance / aggression / substance misuse as a disinhibitor?
Do any of these factors affect the young persons competence to consent?
Consent Scenario
• 2 year old child has been found in the
care of an unrelated man. Her mother
is in custody. The child is put in a place
of safety with maternal grandmother.
• Can she give consent for the
assessment?
Anna
• 13 years old, lives with mother and father.
• Mother has recently taken a new job –
away from home some nights / weekends.
• Anna tells her mother on Wednesday that
her father took her to the garage on
Saturday and “did something” to her.
Anna’s Assessment: 2 + hours
• Consent
• Holistic assessment
– History from police / social care
– Top to toe
• Language
• Examination (takes max 20 minutes)
– Control retained by child (familiar adult + distraction)
– Therapeutic
• Forensic services – in a forensically clean room
– Swabs, clothing
– Photographs, DVD
Immediate treatments for Anna
• Sexual health including prophylaxis for
HIV & STIs
• Immunisations (Hep B / Cervarix)
• Post coital contraception
Follow-up at 2 weeks & 3 months
•
•
•
•
STIs
Counselling
School issues
Other health concerns
Equipment
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•
•
Time
Nursing staff
Admin staff
DS
Bubbles/ stickers
Colposcope
DVD storage
The role of health within
multiagency assessment
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•
•
•
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•
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Reassurance / treatment of child & family
Discussion of findings with professionals
Normal is normal
Report / Statement
Strategy meetings
Case conferences
Court
Recent Cases of Child Sexual Abuse Paediatric Forensic Network
• Remit to see any child 0 -16 years who
has been assaulted or sexually abused
within the previous 7 days within 24
hours
• RVI switch board 0191 233 6161
– Ask for the Children & Young People’s Clinic
(0191 282 4753 direct)
• After 5pm ring RVI and ask for on-call
consultant paediatrician on duty for CSA
Paediatric Forensic Network
• 210 - 230 cases per year
• Covers from Berwick to Teeside and over
to Cumbria
• Funded by Health, Police & PCT
• 6 consultant paediatricians
• 24/7 365 days
• Delivered from the GNCH, RVI
Historical Cases i.e. last contact
> 7 days ago
• Sunderland
– Sue Morris (safeguarding secretary) at
Children’s Centre via switch board 0191
5656256
– Will be seen within a few weeks at the
Niall Quinn Centre, SRH
• Other areas: local arrangements
• Problems – contact PFN for advice
Historical New Patients Sunderland
30
25
20
15
26
10
9
5
0
boys
girls
Historical Age Range Sunderland
14
12
10
8
6
4
2
0
<5 yrs
6yrs-11yrs
12yrs-16yrs
Scenario
• 2 brothers tell their mum that a 12 year old
boy has put their finger up their bums
• She attends A& E with them
• What do you want to know?
• What are you going to do?
Summary
• Think of it!
• Think of PR / consent issues
• Less than 7 days since last episode
– Paediatric Forensic Network, RVI
• More than 7 days
– Local arrangements, contact PFN if problems
• Holistic assessment, takes 2+ hours