EMCYPSAS Clinical Lead March 2018 This text will NOT appear on your slide show. To edit the footer: go to ‘View’ then ‘Slide Master’. Ensure you have the first slide selected Double click ‘First word Second word’ (This is optional for your department, presentation title etc) Click ‘Close Master View’ Proceed as normal Add new slides by clicking on ‘New Slide’ East Midlands Children and Young People Sexual Assault Service EMCYPSAS Fiona Straw EMCYPSAS Clinical Lead March 2018

Operational Model NUH will be the lead provider This text will NOT appear on your slide show. To edit the footer: go to ‘View’ then ‘Slide Master’. Ensure you have the first slide selected Double click ‘First word Second word’ (This is optional for your department, presentation title etc) Click ‘Close Master View’ Proceed as normal Add new slides by clicking on ‘New Slide’ Operational Model NUH will be the lead provider Integrated Hubs with a managed clinical network Each Hub will be a designated suite within hospital Trusts One management team: Clinical Lead Service Manager Data Manager Central data reporting management system to report Key Performance Indicators and other data requirements Shared governance processes, protocols and referral pathways

Clinical Model This text will NOT appear on your slide show. To edit the footer: go to ‘View’ then ‘Slide Master’. Ensure you have the first slide selected Double click ‘First word Second word’ (This is optional for your department, presentation title etc) Click ‘Close Master View’ Proceed as normal Add new slides by clicking on ‘New Slide’ Clinical Model Single point of access answered by a Crisis Support Worker (CSW) - 24 hours per day, 7 days per week, 365 days per year 9am - 7pm working days 9am - 5pm weekend and Bank Holidays - Acute sexual assault/abuse (within 21 days) - Non-recent assault/abuse (more than 21 days) Up to the age of 18 Adults with significant needs (e.g. learning disability) up to age 24 years Young people 16-18 have a choice as to whether they access the CYP or adult services * Inform EMCYPSAS about all CYP to ensure that they get the same access to services

This text will NOT appear on your slide show. To edit the footer: go to ‘View’ then ‘Slide Master’. Ensure you have the first slide selected Double click ‘First word Second word’ (This is optional for your department, presentation title etc) Click ‘Close Master View’ Proceed as normal Add new slides by clicking on ‘New Slide’ East Midlands Children and Young People Sexual Assault Service Regional Hubs

Collection of forensic evidence Documentation of injuries This text will NOT appear on your slide show. To edit the footer: go to ‘View’ then ‘Slide Master’. Ensure you have the first slide selected Double click ‘First word Second word’ (This is optional for your department, presentation title etc) Click ‘Close Master View’ Proceed as normal Add new slides by clicking on ‘New Slide’ Why refer Collection of forensic evidence Documentation of injuries Prevention of unwanted pregnancy Prevention of infections CYP sometimes give medical staff more information Reassure CYP and their carers Onward referrals

Sexually Transmitted Infections Self-harm Domestic abuse This text will NOT appear on your slide show. To edit the footer: go to ‘View’ then ‘Slide Master’. Ensure you have the first slide selected Double click ‘First word Second word’ (This is optional for your department, presentation title etc) Click ‘Close Master View’ Proceed as normal Add new slides by clicking on ‘New Slide’ Operational Model Risk assessment Pregnancy Sexually Transmitted Infections Self-harm Domestic abuse Child Sexual Exploitation Female Genital Mutilation

Onward referrals into local services - Integrated sexual health This text will NOT appear on your slide show. To edit the footer: go to ‘View’ then ‘Slide Master’. Ensure you have the first slide selected Double click ‘First word Second word’ (This is optional for your department, presentation title etc) Click ‘Close Master View’ Proceed as normal Add new slides by clicking on ‘New Slide’ Operational Model Onward referrals into local services - Integrated sexual health - Therapeutic support - CAMHS - Paediatric - ChISVA service

https://www.youtube.com/watch?v=cZD5uFi6SnM Clinical Model This text will NOT appear on your slide show. To edit the footer: go to ‘View’ then ‘Slide Master’. Ensure you have the first slide selected Double click ‘First word Second word’ (This is optional for your department, presentation title etc) Click ‘Close Master View’ Proceed as normal Add new slides by clicking on ‘New Slide’ Clinical Model https://www.youtube.com/watch?v=cZD5uFi6SnM

Single point of access This text will NOT appear on your slide show. To edit the footer: go to ‘View’ then ‘Slide Master’. Ensure you have the first slide selected Double click ‘First word Second word’ (This is optional for your department, presentation title etc) Click ‘Close Master View’ Proceed as normal Add new slides by clicking on ‘New Slide’ Single point of access CSW will answer the phone within 60 secs ‘Hello you are through to the EMCYPSAS and speaking to… how can I help you’ When and where the assault took place Details of the CYP Details of the referrer Have they been referred to CSC Who can give consent, has parental responsibility Do they need an interpreter Do they need urgent medical attention Are they intoxicated Advise Early Evidence Kit collection if appropriate Advise that CYP may need a spare set of clothes

Guide to establishing urgency of sexual offence examination in CYP This text will NOT appear on your slide show. To edit the footer: go to ‘View’ then ‘Slide Master’. Ensure you have the first slide selected Double click ‘First word Second word’ (This is optional for your department, presentation title etc) Click ‘Close Master View’ Proceed as normal Add new slides by clicking on ‘New Slide’ Guide to establishing urgency of sexual offence examination in CYP

Child, young person, family focussed This text will NOT appear on your slide show. To edit the footer: go to ‘View’ then ‘Slide Master’. Ensure you have the first slide selected Double click ‘First word Second word’ (This is optional for your department, presentation title etc) Click ‘Close Master View’ Proceed as normal Add new slides by clicking on ‘New Slide’ Clinical Model Child, young person, family focussed CYP chose who they want to support them Giving control back Fully informed Balance between needs of the child and gathering evidence to safeguard/prosecute Video colposcope

Consent Parent with parental responsibility This text will NOT appear on your slide show. To edit the footer: go to ‘View’ then ‘Slide Master’. Ensure you have the first slide selected Double click ‘First word Second word’ (This is optional for your department, presentation title etc) Click ‘Close Master View’ Proceed as normal Add new slides by clicking on ‘New Slide’ Consent Parent with parental responsibility YP if has capacity and is competent Written Countersigned Unable to do examination without, unless life threatening History taking Documentation Examination Collection of samples Use of colposcope Written report

Clinical Model Police, CYP and their carer greeted by CSW This text will NOT appear on your slide show. To edit the footer: go to ‘View’ then ‘Slide Master’. Ensure you have the first slide selected Double click ‘First word Second word’ (This is optional for your department, presentation title etc) Click ‘Close Master View’ Proceed as normal Add new slides by clicking on ‘New Slide’ Clinical Model Police, CYP and their carer greeted by CSW Holistic assessment by single doctor supported by CSW - Physical examination Documentation of injuries including use of a colposcope Collection of forensic samples Urinary pregnancy testing - PEPSE provision Emergency contraception Screening and treatment for Sexually Transmitted Infections

Clinical Model This text will NOT appear on your slide show. To edit the footer: go to ‘View’ then ‘Slide Master’. Ensure you have the first slide selected Double click ‘First word Second word’ (This is optional for your department, presentation title etc) Click ‘Close Master View’ Proceed as normal Add new slides by clicking on ‘New Slide’ Clinical Model

Forensic sample collection This text will NOT appear on your slide show. To edit the footer: go to ‘View’ then ‘Slide Master’. Ensure you have the first slide selected Double click ‘First word Second word’ (This is optional for your department, presentation title etc) Click ‘Close Master View’ Proceed as normal Add new slides by clicking on ‘New Slide’ Forensic sample collection Skin samples 48 hours (up to 7 days if haven’t washed) Oral penetration 48 hours Anal penetration Digital 48 hours Penile 72 hours Vaginal penetration Penile 7 days

Forensic sample collection This text will NOT appear on your slide show. To edit the footer: go to ‘View’ then ‘Slide Master’. Ensure you have the first slide selected Double click ‘First word Second word’ (This is optional for your department, presentation title etc) Click ‘Close Master View’ Proceed as normal Add new slides by clicking on ‘New Slide’ Forensic sample collection Blood sample Drug/alcohol 3 days Urine sample Drug/alcohol 5 days Hair From 4-6 weeks Up to 6 months Avoid cutting hair and chemically treatments

Hand written summary of allegation and opinion Clear follow up plan This text will NOT appear on your slide show. To edit the footer: go to ‘View’ then ‘Slide Master’. Ensure you have the first slide selected Double click ‘First word Second word’ (This is optional for your department, presentation title etc) Click ‘Close Master View’ Proceed as normal Add new slides by clicking on ‘New Slide’ Clinical Model Hand written summary of allegation and opinion Clear follow up plan Contact number for CYP and their carer Formal typed report for all cases Statement as requested Daily review of cases Regular peer review and supervision of staff Ongoing training and updates

Network of CYP Sexual Assault Services Peer review of similar services This text will NOT appear on your slide show. To edit the footer: go to ‘View’ then ‘Slide Master’. Ensure you have the first slide selected Double click ‘First word Second word’ (This is optional for your department, presentation title etc) Click ‘Close Master View’ Proceed as normal Add new slides by clicking on ‘New Slide’ Service development Network of CYP Sexual Assault Services Peer review of similar services Development of the service website Stakeholder and service user participation to inform service development Education and awareness raising

Improved recording of sexual offences by the police This text will NOT appear on your slide show. To edit the footer: go to ‘View’ then ‘Slide Master’. Ensure you have the first slide selected Double click ‘First word Second word’ (This is optional for your department, presentation title etc) Click ‘Close Master View’ Proceed as normal Add new slides by clicking on ‘New Slide’ Activity All UK nations saw an increase in the number of recorded sexual offences against children in 2015/16. Improved recording of sexual offences by the police Increased willingness of victims to come forward The rate of recorded sexual offences across the UK has doubled since 2005/06 2015/16 seeing the highest number of offences in the past decade.

Activity Assumptions Exact prevalence is unknown This text will NOT appear on your slide show. To edit the footer: go to ‘View’ then ‘Slide Master’. Ensure you have the first slide selected Double click ‘First word Second word’ (This is optional for your department, presentation title etc) Click ‘Close Master View’ Proceed as normal Add new slides by clicking on ‘New Slide’ Activity Assumptions Exact prevalence is unknown In 2014/15, in UK, 45,631 reports to the police NSPCC survey 2011 18-24 year olds 11% considered that they had been sexually abused as child 34% 11-17 year olds who had experienced contact CSA by an adult did NOT disclose 83% 11-17 yr olds who experienced contact CSA by a peer did NOT disclose 90% by someone they know

Activity Assumptions NHSE data suggests 600 cases per annum This text will NOT appear on your slide show. To edit the footer: go to ‘View’ then ‘Slide Master’. Ensure you have the first slide selected Double click ‘First word Second word’ (This is optional for your department, presentation title etc) Click ‘Close Master View’ Proceed as normal Add new slides by clicking on ‘New Slide’ Activity Assumptions NHSE data suggests 600 cases per annum ~400 Nottingham hub ~200 Northampton hub 2/3 cases non-recent 1/3 cases acute Research suggests 5-10% of the population at risk Population of the region ~ 1 million 50-100,0000 CYP

This text will NOT appear on your slide show. To edit the footer: go to ‘View’ then ‘Slide Master’. Ensure you have the first slide selected Double click ‘First word Second word’ (This is optional for your department, presentation title etc) Click ‘Close Master View’ Proceed as normal Add new slides by clicking on ‘New Slide’ Contact Details All referrals acute and non-recent telephone 0800 1830023 General enquiries e.g. statement requests Nottingham 0115 8754595 Northampton 01604 745005 Website www.emcypsas.co.uk

Questions This text will NOT appear on your slide show. To edit the footer: go to ‘View’ then ‘Slide Master’. Ensure you have the first slide selected Double click ‘First word Second word’ (This is optional for your department, presentation title etc) Click ‘Close Master View’ Proceed as normal Add new slides by clicking on ‘New Slide’ Questions