FAQ for Children and Young people
The Sexual Abuse Assessment Service for Children and Young People is an NHS commissioned service for children and young people where there is a disclosure / allegation or concern of sexual abuse or assault. The service provides forensic medical assessments to ensure the health and wellbeing of these children and young people, as well collecting forensic evidence where appropriate.
Who is the service for?
The service is available for all children and young people, girls and boys, aged 17 and under from Devon and Torbay who may have suffered sexual assault or abuse. The service is also available for children aged 15 years and under from Plymouth, if the alleged or suspected abuse happened recently (for non-recent abuse/assault, children can be referred to Derriford hospital whilst 16-17 year olds are seen at Plymouth SARC by the Sexual Offence Examination Service).
It is recognised that children often find it difficult to talk about or explain what has happened to them. Delayed, piecemeal and incomplete disclosures are common. Our service is therefore available to all children where there is a concern regarding sexual abuse, even if there has not been a clear disclosure.
What is a forensic medical assessment?
The forensic medical assessment is holistic assessment that considers the physical and mental wellbeing of the child as well as identifying any opportunities for the collection of forensic evidence for criminal investigations and / or court proceedings. The assessment process and aftercare has many important and valuable therapeutic aspects.
The assessment may include:
- Asking questions about a child’s medical, family and social background.
- A routine medical examination, including listening to heart and lungs, feeling the abdomen, checking ears, nose and throat.
- Checking for injuries on all body surfaces, as well as the external genitalia and external anal area.
- Considering if any forensic samples are required and if so collecting these samples. Samples may include urine samples and swabs (like a cotton bud that is wiped over the surface of the skin).
- Answering questions and talking about concerns that a child or their parents may have
- Discussing the risk of sexually transmitted infections, such as Chlamydia and Gonorrhoea, together with HIV and hepatitis B infections from the assault/abuse
- Considering if any samples are required to look for infections
- In females, considering if emergency contraception, such as the ‘morning after pill’ is needed. This can be provided at the time of the forensic medical assessment.
During the forensic medical assessment, the doctors may use some special equipment, such as a colposcope. The colposcope is a light with a special camera attached to it, which allow photographs or video to be created of the genital and anal examination (as long as the child agrees to this). The pictures / videos are stored safely and securely and do not have patient identifiable information on them. The pictures / videos can help prevent a child being re-examined later and can provide valuable information for police and social care. However, only medical professionals are allowed to look at these images.
The assessment process can seem a little daunting for children, young people and their families, so we provide a safe and supportive environment and allow families to take it at their own pace. We have a range of toys and games for children to play with to help them relax and feel comfortable, whilst our specialist nurse provides invaluable support for child and their families throughout the process.
What are the benefits of a forensic medical assessment?
There are many benefits of a forensic medical assessment, which we believe is a holistic process to address the medical, forensic, safeguarding and overall wellbeing of the child. Some of the many benefits are:
- Assessment and recording of injuries
- Identification of any medical needs that require treatment
- Making appropriate onward referrals
- Reassurance regarding physical well being
- Provision of emergency contraception and medication to reduce the risk of infections (HIV) if required
- An opportunity to discuss any medical, psychological or behavioural concerns
- Collecting forensic samples and other information of evidential value
Does the examination hurt? Do children find it difficult?
Sometimes children find forensic swabs can be a little uncomfortable, but most children say they tickle rather than hurt. Otherwise the assessment is just looking and gentle touching on the outside only, and it does not hurt. With the exception of some older sexually-active teenagers, examinations are always limited to external looking only – we do not do internal examinations or use speculums on children.
Examination of the genitalia and anal area can be embarrassing and some children find it upsetting. The doctors are very experienced at reassuring children and making the examination as easy as possible for them. If any child becomes upset or distressed by an examination, it would be stopped. However, most children find the process quite easy and straightforward.
Many children find the assessment process and very positive and reassuring experience. We regularly receive feedback from children and young people saying they most valued the following aspects of the service:
- Being listened to and believed in a safe and non-judgemental environment
- The opportunity to ask questions and talk about the things that are worrying them
- Being given choices and control over what happened
- Being given reassurance that they are physical healthy
- Support with contacting other services afterwards
Who does the assessment?
We are a team of forensic medical examiners, paediatricians and specialist nurses. Forensic medical assessments are generally done by a one or two doctors (two doctors are usually present for younger children) with the support of a specialist nurse.
We understand it can be difficult for children and young people to talk about what has happened. We help and support children, young people and families, spending time getting to know all involved, gaining trust and help ensure the experience is both positive and reassuring.
What happens after the assessment?
The assessment involves development of a plan for ongoing care, with onward referral to other appropriate professionals and agencies.
As part of ongoing care we will arrange follow-up approximately two weeks after the initial assessment. This may either be a face-to-face appointment if clinical review is required or by telephone call with the Specialist Nurse as a general welfare check.
After every forensic medical assessment, a medical report is completed. This report provides details of the child’s medical background, the discussions that occurred during the assessment and any examination findings. We also highlight any ongoing safeguarding concerns, referrals to other services any action required by others. The report is usually shared with police, children’s social care, the child’s general practitioner and usually the school nurse or heath visitor.
Where will assessment take place?
They take place at The Oak Centre, a Sexual Assault Referral Centre in Exeter. It is in a discrete location and provides young person-friendly facilities.
When is the service available?
Acute assessments take place five days a week, Monday to Friday 9am – 5pm (including Bank Holidays). Historic assessments take place in weekly clinics. All assessments are by appointment only.
Outside of these hours if there are acute medical needs, such as injury, general practitioners or the local accident and emergency department should be contacted.
How do I refer into the service?
If the alleged or suspected sexual abuse occurred within the last 10 days, we would recommend you telephone and speak to one of our clinicians to discuss the case. Most of these children will require an “acute” assessment to assess any injuries, provide therapeutic care (for example, emergency contraception) and collect forensic samples where appropriate. The service clinicians can be contact through the G4S Health call centre.
If the alleged or suspected abuse occurred in the past (the most recent incident at least 10 days ago) then an ‘historic’ assessment in one of our weekly clinics may be more appropriate. A referral for this can be made via the joint Oak Centre / Sexual Abuse Assessment Service referral form.
I am not sure whether to refer or not, what do I do?
There are many reasons why children can be referred to our service. Our referral criteria include, but is not limited to the following:
- A disclosure of sexual abuse
- Sexually transmitted infection (incl. genital herpes & warts) in a pre-pubertal child or non-sexually active young person
- Unusual sexualised behaviour (in the absence of a developmental disorder)
- Alerting features in the absence of a clear disclosure:
– Anogenital symptoms (bleeding, discharge or soreness)
– Return to bedwetting or soiling having been previously dry/ continent
– Repeated urinary tract infections
– Mental health problems
– Behavioural changes
– Alcohol and drug use
- Sibling/friend of an index child
- Worrying history of contact with a known sex offender
If you are unsure whether a child should be referred to our service, we would be pleased to discuss the details with you (via G4S Health call centre) and advice. Alternatively, if the most recently alleged or suspected incident of sexual abuse was more than 10 days ago, you can complete a joint referral form for The Oak Centre / Sexual Abuse Assessment Service for Children and Young People (please indicate whether or not you have discussed with the child or their family the possibility of a forensic medical assessment). When we receive the referral form we will review the details and determine if a forensic medical assessment is indicated.
What happens after I complete a referral form?
All referral forms received for children and young people aged 17 years and under are automatically reviewed by the Sexual Abuse Assessment Service for Children and Young People. We have a weekly case management meeting between the Oak Centre and the Sexual Abuse Assessment Service for Children and Young People, during which, a plan is made as to whether a child should be seen by the Sexual Abuse Assessment Service.
If an appointment for a forensic medical assessment is required, our specialist nurse will make direct contact with the child, young person and their families to arrange an appropriate date and time for them to attend.
Who pays for the forensic medical assessment?
The Sexual Abuse Assessment Service for Children and Young People is commissioned by NHS England therefore all assessments are included with in the service specification. There would be no additional charge to the police, SARCs, or the NHS for any forensic medical assessments carried out.
The child hasn’t made a clear disclosure, do they need a forensic medical assessment?
If there are concerns that the child may have experienced sexual abuse, it is recommended that they are referred for a forensic medical assessment. We know all children, and particularly younger children find it difficult to describe what has happened to them. This can result in unclear, piecemeal, delayed or even absent disclosures. We do not require a clear disclosure from the child in order for them to be referred to our service.
If you are unsure, please contact us to discuss the details of your particularly case and we can advise accordingly.
It’s outside the forensic window so is there any point having a forensic medical examination?
Yes, a forensic medical examination may still be beneficial. We can still address any medical needs the child may have amongst other therapeutic benefits. We may not be able to collect forensic samples but there may be other signs that are of value to a police investigation. The most important aspect is the health and wellbeing of the child and therefore a referral for a forensic medical assessment would still be beneficial for the child and their family.