St Mary’s Children’s SARC The Manchester Experience

1. St Mary’s Children’s SARCThe Manchester Experience Dr Catherine White March 2011

2. Opened 1986 • Adult service • Acute child cases

3. 2.5 million in 2005 • 2.8 million in 2010

4. 1986 15,000 clients All ages Male & female Children’s SARC Feb 2006 400 Children per year 4 Dr Catherine White

5. St. Mary’s CentreCore 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 5 Dr Catherine White

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

7. What is a child? 7

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

11. The examination suite

13. St Mary’s Child Cases

14. Child Cases 2009

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 15 Dr Catherine White

16. The process • Referral made to SARC • Examination • Review of notes next working day • Re-contact by Child Advocate • Support video interview • Counselling • STI screening

17. 17 Dr Catherine White

18. SARC SAFEGUARDING PATHWAY Initial contact with SARC Risk assessment child protection/vulnerable adult Immediate action required NO immediate action required Letter to GP (Copy to Social care) Telephone referral to Social Care EDT* Fax completed MARF** to EDT (place copy of MARF in notes and contact EDT to check receipt) Case reviewed next working day Referral to Trust Safeguarding Team Complete MARF (copy in notes) Copy of MARF to Trust Safeguarding Team (next working day) (copy of MARF in notes) Letter to GP 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

19. Medical rota • Day time clinics three days a week. • Out of hours rota to cover child and adult cases. • Single doctor examinations

20. Quality Feedback Dashboard Peer review Qualifications

21. Feedback forms

24. Peer Review • Monthly process • Not diagnosis by consensus • Challenge v nurturing • External peer review

25. 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)

26. Children as a total of all cases 2006-2011

27. Age of Children Seenlast 5 years

28. Gender of Children Seen

29. Problems… • Commissioning • Capacity • Resistance to refer • Evolution

30. 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.

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

32. Inter Agency WorkingDoes it work?

33. Are the health needs met?

34. Review of statement requests January 2006 - December 2010

35. Under 13sCases where statement is requested.

36. The assailants of the Under 13s • Male • Known to child • Adults 60% • 95% either adult or at least 5 years age difference

37. 95 % were non stranger cases

38. Injuries varied from abrasions to lacerations requiring surgery.

40. The Future…. • Adolescent suite • Increase Child Advocate capacity • Centres of excellence • Social worker on site • Increase psychological support • Preventative work

41. THANKYOU 0161 276 6515 www.stmaryscentre.org Stmarys.sarc@cmmc.nhs.uk Catherine.white2@nhs.net Dr Catherine White