1. REVIEW OF Child Sexual Abuse (CSA) Services in the Eastern Region
Eastern Regional
Health Authority
October 2003

2. Terms of Reference
Establish the background to the development of the specialist CSA units
Describe the referral process to CSA services from a variety of agencies.
Delineate the criteria for prioritisation in the assessment and treatment process.
Establish the current staffing levels and CSA unit structures.
Review the current waiting lists for CSA services.
Identify possible developments for support services for children whilst awaiting access to CSA services.
Describe the current process for accessing appropriate treatment services.

3. Referral Sources Referrals from Community Care
Referrals from Hospitals
Referrals from GPs and other professionals
Referrals from Parents and relatives
Referrals from Gardai

4. Difficulties with referral process
Community Services
- Lack of clarity of role
- Inadequate facilities
- Training & Upskilling
- Recruitment & Retention
CSA units
- Inappropriate referrals
- Lack of clarity on role and function
- Location at hospital site
A&E Services
- Single- handed consultant appointments
- Lack of out-of-hours provision
- Insufficient numbers to develop expertise

5. Factors associated with waiting times for assessment
Staff vacancies
Complexity of cases
Increased referrals from CCA services
Awaiting further information
Training commitments
Demands from courts

6. Elements of an effective CSA Service
Provide prompt access to assessment services, in order to identify the response and treatment needs of the child and caregivers.
Provide access to treatment services based on the care needs of the child and caregivers at a time appropriate to the child.
Liaise and co-ordinate the care planning and care delivery process across a number of community and specialised services.
Offer clearly defined referral pathways between community, secondary and tertiary services.
Provide services that are based on best practice and high quality evidence.

7. Findings
Lack of clarity of purpose and function of community and specialist units.
Perceived lack of mandate at community level in assessment function.
This lack of clarity has resulted in inappropriate referrals to specialist units.
The absence of clear referral pathways for other referrers and stakeholders.
Recruitment and retention issues in both community and CSA units.
Lack of appropriate facilities in community based services for assessment even where the teams have capacity and expertise.
Increasing demands from the courts for specialist evidence.
Until recently A&E Consultants were single-handed in each Paediatric Hospital and only one of three hospitals have a paediatric on-call service.
The numbers presenting for medical examination are very small and the opportunities for developing expertise in medical examinations is constrained.

8. Key Issues
Firstly, the need to provide an integrated holistic service to children and their families in relation to all child abuse.
Secondly, the need to develop a model of service delivery which enables the specialist units to deliver on their specialist, consultative assessment and therapeutic function.
Thirdly, the need to develop a medical response service which could at a very minimum provide a 24 hour medical assessment service.

9. Recommendations
Agree and produce statement of purpose and function of community and CSA units.
Clarify roles and responsibilities of each service in the areas of assessment and therapy.
Agree and produce referral guidelines for referral to Community services and to CSA units.
Disseminate guidelines to all stakeholders and offer consultation and input regarding implementation of guidelines.
Assess and prioritise vacant posts in the specialist units.
Assess staffing needs in community services.
Develop appropriate facilities in community services to enable assessments to be carried out at community level.
Examine the potential for development of a single medical response unit aimed at providing comprehensive 24 hour medical assessment.

10. Implementation
The ERHA will facilitate a detailed consultative process during the remainder of 2003 with the specialist and community based services.
The CSA units will initiate Consultation with Community Services to develop best practice guidelines.
The above consultation processes should facilitate some immediate improvements in referral patterns.
The ERHA will continue its liaison with the Department of Health and Children regarding resource requirements for this service.(priority for 2004).
The Paediatric A&E services in collaboration with the specialist and community services will explore the proposals for the development of a medical response service.
Consultation with wider stakeholders regarding referral pathways will be undertaken .