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 million in 2010

Dr Catherine White ,000 clients All ages Male & female Children’s SARC Feb Children per year

Dr Catherine White 5 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

Problems Not a child friendly environment Increasing child numbers Lack of staff to deal with children – ISVAs – Counselling – Doctors

7 What is a child?

Operation Artemis Board established Current demand Agree pathways Identify site Secure funding

The examination suite

St Mary’s Child Cases

Child Cases 2009

Dr Catherine White 15 The Team 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

The process 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 17

Telephone referral to Social Care EDT* Fax completed MARF** to EDT (place copy of MARF in notes and contact EDT to check receipt) SARC SAFEGUARDING PATHWAY Initial contact with SARC Immediate action required Risk assessment child protection/vulnerable adult Letter to GP (Copy to Social care) Case reviewed next working day NO immediate action required Referral to Trust Safeguarding Team Complete MARF (copy in notes) Letter to GP Copy of MARF to Trust Safeguarding Team (next working day) (copy of MARF in notes) 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 NovDecJan92%92% Benchmark Quality and Safety ISVA Safeguarding % attendance counselling supervision 100% Re contacting : 5 working days 98% 86%95% % notes reviewed : 1 working day 100% % MARF : 1 working day98%94%96%100% MedicalAllergy documentation97.5%97%95%98% Correct HIV PEP Script100% 98% Chain of custody99%100% 98% Gaps on <13 rota7/38 (18%)6/38 (16%)7/41 (17%)<5% Gaps on >13 rota1/68 (1.5%) 4/73 (5%)< 5% Child serviceWorking days to next appointment 432.5<3 % pre pubertal Colposcopic exam 100% > 95% % marked of interest peer review 100% % DVD marked normal peer review 30% 40%>10% Training and Development Corporate mandatory training 92% 100% Clinical mandatory training 50% 100%

Domain Indicator NovDecJanBenchmark Centre Activity Children Total cases Adults52 (56%)42 (53%)54 (55%) Children40 (40%)37 (47%)44 (45%) Children (55%)19 (51%)15 (34%) Children (45%)18 (49%)29 (66%) Acute child22 (55%)27 (73%)26 (59%) Non acute child18 (45%)10 (27%)18 (41%) All cases%Forensic Exam80 (87%)63 (80%)80 (81%) Client source%self referral15.2%21%17%> 15% % female83 (90%)74 (94%)91 (93%)< 90% % male9 (10%)5 (6%)7 (7%)> 10% % BME groups23%14%8%9% %ethnic record100%97%98% Police referrals% Police referrals84.8%79%83% % reported to policeUK CounsellingNew referrals % police referral44% (8/18)10% (2/19)11.5% (5/43) Waiting list time6 wks4 weeks6 wks< 8 wks Active caseload DNA rate11.2%15%9%<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

Age of Children Seen last 5 years

Gender of Children Seen

Problems… Commissioning Capacity Resistance to refer Evolution

Reasons to refer…. 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.

Dr Catherine White 31 Criminal Justice Issues Support through video interview Pre trial visit Witness and Victim Support Services Pre trial therapy Disclosure Outcomes Post court

Inter Agency Working Does it work?

Are the health needs met?

Review of statement requests January December 2010 Total numbersStatement cases% All cases Adults % Children % Females under % Female children % Male under % Male children %

Under 13s Cases where statement is requested.

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

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

Dr Catherine White41 THANKYOU