St Mary’s Children’s SARC
The Manchester Experience
Dr Catherine White
March 2011
• Opened 1986
• Adult service
• Acute child cases
• 2.5 million in 2005
• 2.8 million in 2010
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1986
15,000 clients
All ages
Male & female
Children’s SARC Feb
2006
• 400 Children per year
Dr Catherine White
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St. Mary’s Centre
Core Services
Forensic medical examination
Emotional and practical support
One-to-one counselling for clients and supporters
Post-coital contraception and pregnancy testing
Post exposure prophylaxis
Screening for STIs and HIV counselling
24-hour telephone support and information
Support through criminal proceedings
Training and consultancy services
• Children’s SARC
Dr Catherine White
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Problems
• Not a child friendly environment
• Increasing child numbers
• Lack of staff to deal with children
– ISVAs
– Counselling
– Doctors
What is a child?
7
Operation Artemis
• Board established
• Current demand
• Agree pathways
• Identify site
• Secure funding
The examination suite
St Mary’s Child Cases
450
400
350
300
250
200
150
100
50
0
no of child cases
2005
2006
2007
2008
2009
2010
250
389
378
438
442
426
Child Cases 2009
200
180
160
140
120
100
80
60
40
20
0
no
0-4
5-9.
10-14.
15-17.
78
85
98
181
The Team
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Crisis Workers x 11
Forensic Physicians x 26
Counsellors x 4
ISVA
Child Advocate x 2
Consultant Paediatrician
Centre Manager
Researcher
Police Liaison Officer
Clinical Director
Dr Catherine White
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The process
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Referral made to SARC
Examination
Review of notes next working day
Re-contact by Child Advocate
Support video interview
Counselling
STI screening
Dr Catherine White
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SARC SAFEGUARDING PATHWAY
Initial contact with SARC
Risk assessment
child protection/vulnerable adult
Letter to GP
(Copy to Social care)
Immediate action required
NO immediate action required
Telephone referral to Social Care EDT*
Fax completed MARF** to EDT
Case reviewed next working day
(place copy of MARF in notes and
contact EDT to check receipt)
Copy of MARF to Trust Safeguarding Team
(next working day)
(copy of MARF in notes)
Referral to Trust Safeguarding Team
Complete MARF
(copy in notes)
Letter to GP
All children aged 17 years and under and vulnerable adults attending SARC will be referred to the Trust Safeguarding Team.
Where there is concern for the patient’s (or child’s) safety the Emergency Duty Team (EDT), Children and Families should be
contacted. This protocol should be considered in conjunction with Trust Safeguarding Policy. This is available on the Trust
intranet link to Child protection all SARC staff should familiarise themselves with it.
*EDT Emergency Duty Team
** MARF Multiagency Referral Form
To be actioned immediately
To be actioned the next working day
Medical rota
• Day time clinics three days a week.
• Out of hours rota to cover child and adult
cases.
• Single doctor examinations
Quality
• Feedback
• Dashboard
• Peer review
• Qualifications
Feedback forms
Domain
Indicator
Nov
Dec
Jan
Quality and Safety
% attendance counselling
supervision
100%
100%
100%
ISVA
Re contacting : 5 working
days
98%
98%
86%
95%
Safeguarding
% notes reviewed : 1
working day
100%
100%
100%
100%
% MARF : 1 working day
98%
94%
96%
100%
Allergy documentation
97.5%
97%
95%
98%
Correct HIV PEP Script
100%
100%
100%
98%
Chain of custody
99%
100%
100%
98%
Gaps on <13 rota
7/38 (18%)
6/38 (16%)
7/41 (17%)
<5%
Gaps on >13 rota
1/68 (1.5%)
1/68 (1.5%)
4/73 (5%)
< 5%
Working days to next
appointment
4
3
2.5
<3
% pre pubertal
Colposcopic exam
100%
100%
100%
> 95%
% marked of interest peer
review
100%
100%
100%
100%
% DVD marked normal
peer review
30%
30%
40%
>10%
Corporate mandatory
training
92%
92%
92%
100%
Clinical mandatory
training
50%
50%
50%
100%
Medical
Child service
Training and
Development
9 Benchmark
2
% 100%
Domain
Indicator
Nov
Dec
Jan
Centre Activity
Total cases
92
79
98
Adults
52 (56%)
42 (53%)
54 (55%)
Children
40 (40%)
37 (47%)
44 (45%)
Children 0-12
22 (55%)
19 (51%)
15 (34%)
Children 0-17
18 (45%)
18 (49%)
29 (66%)
Acute child
22 (55%)
27 (73%)
26 (59%)
Non acute child
18 (45%)
10 (27%)
18 (41%)
All cases
%Forensic Exam
80 (87%)
63 (80%)
80 (81%)
Client source
%self referral
15.2%
21%
17%
> 15%
% female
83 (90%)
74 (94%)
91 (93%)
< 90%
% male
9 (10%)
5 (6%)
7 (7%)
> 10%
% BME groups
23%
14%
8%
9%
%ethnic record
100%
97%
98%
98%
% Police referrals
84.8%
79%
83%
% reported to police
UK
UK
UK
New referrals
18
19
43
% police referral
44% (8/18)
10% (2/19)
11.5% (5/43)
Waiting list time
6 wks
4 weeks
6 wks
Active caseload
43
49
52
DNA rate
11.2%
15%
9%
Children
Police referrals
Counselling
Benchmark
< 8 wks
<15%
Peer Review
• Monthly process
• Not diagnosis by consensus
• Challenge v nurturing
• External peer review
Qualifications
• 26 female forensic physicians
– 22 in place more than 12/12
– 22 are either Consultants or GPs
• 50% have MFFLM
• 100% FMERSA course
• Additional payment for higher qualifications
• (FNEs for 9 years until 2009)
Children as a total of all cases 2006-2011
44%
56%
Adults
Children
Age of Children Seen
last 5 years
43%
57%
13-17 years
Under 13 years
Gender of Children Seen
13%
Girls
Boys
87%
Problems…
• Commissioning
• Capacity
• Resistance to refer
• Evolution
Reasons to refer….
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Assessment and treatment of any possible injuries
Documentation of injuries
General health assessment
Reassurance
Recovery of trace evidence e.g. semen, DNA, lubricants etc
Screening and if necessary treatment of sexually transmitted infections.
Emergency contraception
Pregnancy testing
Post exposure prophylaxis for HIV and Hepatitis B
Psychological support for complainant and carers.
Practical support through the criminal justice process.
Criminal Justice Issues
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Support through video interview
Pre trial visit
Witness and Victim Support Services
Pre trial therapy
Disclosure
Outcomes
Post court
Dr Catherine White
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Inter Agency Working
Does it work?
Are the health needs met?
Review of statement requests
January 2006 - December 2010
Total numbers
Statement cases
%
All cases
4646
1008
22
Adults
2614
573
22%
Children
2032
435
21%
Females under 13
673
119
18%
Female children 13-17
1093
262
24%
Male under 13
203
42
21%
Male children 13-17
63
12
19%
Under 13s
Cases where statement is requested.
46%
54%
Acute
Historic
The assailants of the Under 13s
• Male
• Known to child
• Adults 60%
• 95% either adult or at least 5 years age
difference
95 % were non stranger cases
Brother
Dad
Grandfather
Step grandfather
Uncle
Friend of Family
Cousin
Neighbour
Mum's boyfriend
Stepfather
Acqaintance
Baby sitter
Boyfriend
Sister
Friend
Injuries varied from
abrasions to
lacerations requiring
surgery.
The Future….
• Adolescent suite
• Increase Child Advocate capacity
• Centres of excellence
• Social worker on site
• Increase psychological support
• Preventative work
THANKYOU
0161 276 6515
www.stmaryscentre.org
Stmarys.sarc@cmmc.nhs.uk
Catherine.white2@nhs.net
Dr Catherine White
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