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FORENSIC SERVICES FOR

MEDICAL EXAMINATIONS
OF CHILDREN AND YOUNG
PEOPLE
Dr Amanda Thomas
Dr. Karen Rollison
Gillian Finch
Angela Connor

Sexual Abuse Services


ν Many challenges to the varied agencies
ν A variety of functions and roles which must
be carried out in a coordinated and
integrated manner.
ν Children & YP often do not disclose for
days, weeks, months or even years later.
ν Any service should be willing to see, assess
and meet the needs of all these individuals,
whether they present as an acute or a
historical problem.

Priorities for Services


ν First priority - health and welfare of the
child.
ν Collection of (forensic) evidence is
important but must take place alongside the
health and welfare needs of the child - it
must not be seen as the first and only priority
ν In many cases the health and forensic needs
cannot be easily separated and need to be
dealt with together

1
The Legal Context
ν Few cases reach the legal system (civil or
even criminal)
ν Most children remain within their families -
protection secured by multi-agency
working together.
ν Recognition of abuse - “jigsaw picture”
picture”.
ν Specific diagnostic / forensic information is
available in a small minority of cases of
CSA

Clinical presentation/physical
evidence
ν Few or no physical signs/ little forensic
evidence.
ν Specific forensic material more likely in
older adolescent girls promptly reporting
rape.
ν Largest group: aged 2 – 8 years, abused
by family or extended family member,
babysitter, neighbour , etc

Younger children
ν Minority disclose - investigation starts at a
different point to children &YP able to
describe and report their abuse.
ν Likely to present to: primary care, hospital,
community, out of hours service or A & E,
school/nursery with physical injury,
behavioural symptoms, signs of emotional
distress or psychosomatic symptoms.
ν Planned services need to cater for all forms
of abuse

2
Functions of the Service
ν Paediatric evaluation:
ν comprehensive health assessment (growth &
development)
ν specific forensic orientated medical examination
with attention to accurate injury definition and
description
ν STI, pregnancy testing, & PCC
ν Interviewing and assessment of the child by
police and social services
ν Interviewing and assessment of the family

Functions of a Service
ν Joint working of disciplines/agencies
ν Provision of follow up
ν Provision of reports/statements
ν Presentation of evidence in court.
ν Referral on for specific needs e.g.
involvement of therapeutic services

Provision / Requirements
ν Well funded, dedicated child and adolescent
friendly, clinical unit, part of secondary
paediatric services.
ν Centralised near to a hospital (allows access
to further specialist health assessments,
inpatient facilities, investigations)
ν Dedicated and specifically trained
children’
children’s staff
ν Service provided a on a daily basis.
ν Responsible for seeing children from local
catchment area.

3
Professional Issues
ν Sufficient staff for rotas & mutual support.
ν Staff part of a network with wider
responsibilities outside the centre (devote
sessions to the centre’
centre’s work). Most staff
need to balance their work with other areas
of practice.
ν Service provided for some part or all of
every day, including weekends.
ν Adequate and appropriately trained nursing
& therapeutic staff.
ν Adequate administrative support staff

Professional resources
ν Facilities for:
ν medical assessment & follow up
ν video interview,
ν interviewing of parents/carers
ν evidence collection / storage e.g. lab specimens,
ν Colposcopy & photo- documentation
ν Shared and integrated databases of patients/clients
? Multiagency and link in to a national/local
children’
children’s database
ν Training and development resources
ν Appropriate emotional & clinical
support/supervision systems
ν Peer review at regular intervals.

New Challenges
ν Commissioning/Provision – Police?
PCTs?
PCTs? PBCs?
PBCs? Private providers?
ν Agreed Models of Service
ν Standards
ν Equity of access
ν Sufficient appropriately trained staff
ν Succession Planning

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