If a child has told someone that they have been sexually abused, a Strategy Discussion should be arranged with attendance from Dorset Police and NHS Dorset, in addition to Children’s Services, as a minimum so that decisions may be made about securing evidence; this may include a medical examination at the Sexual Assault Referral Centre (SARC) [1]. Refer to Standards for Child and Family Assessments and S47 enquiries [2] and Achieving Best Evidence interviews (ABE). [3]
There should be consultation with the Safeguarding Paediatrician prior to the Strategy Discussion.
Child Protection medical examination when sexual abuse is suspected: The timing will depend on the nature of the alleged assault and the timing of the last incident, so it is key that any reports from a child that they have been sexually abused are dealt with immediately. A child protection medical examination is an opportunity for holistic assessment of all aspects of a child’s health and wellbeing encompassing both physical and mental health. The assessment has multiple purposes including reassurance to the child about their health, managing any medical issues that need addressing and, in some cases, gathering forensic evidence.
Evidence for the impact of medical examinations in CSA and good practice guidance for conducting them may be found in The Centre of Expertise Report on the Role and Scope of Medical Examinations. [4] The review states “Medical examinations have a valuable place in the holistic assessment of abused children’s health and wellbeing”. It gives guidance to professionals about how these examinations should be conducted including the importance of the child having control about what is happening. It states “All and any part of the examination is optional for the child and young person. They can choose (including on the day) which parts of the examination they want and can change their mind at any time.” It also states “The time of medical examination might be an opportunity to influence discourse within the family and identify carers’ support needs. The access to and referral for therapeutic support facilitated at these health assessments should consider the wider family as a matter of routine”. This is particularly important as the long term outcomes for abused children and young people are influenced by many factors but include the support they receive from their non-abusing close family who may themselves be in need of support in coping with what has happened. Therefore, as part of your assessments and interventions consider the wider family networks in any plans for the child.
For sexual assault within the previous 7 days a strategy discussion must be held between social care, police and should include a Paediatrician from the Safeguarding Team at UHD Poole Hospital and/or the Forensic Medical Examiner at The Shores/SARC. The timing of the medical assessment will be affected by the possibility of acquiring forensic evidence and whether the child / young person is likely to need urgent medical treatment. The medical services for this group of children and young people are based at The Shores (Sexual Assault Referral Centre, Bournemouth). The Medical Examination in Child Protection Cases [5] gives the relevant contact details. Historical abuse A strategy meeting should be convened with a Paediatrician from The Safeguarding Team at UHD Poole Hospital (contact no. 0300 019 8312). Please see HERE [6] for a leaflet that can be provided to young people and parents/carers, which provides further information about what they can expect in a genital examination.
Procedure for siblings in a child protection medical examination
The PDSCP have developed a procedure around including siblings within a child protection medical examination which can be found here [7]
Consideration of a specialist assessment
A Child Protection Conference (CPC) should only consider use of a specialist assessment where:
- There is a clear and specific rationale for arranging such an assessment. What insight or understanding will the assessment bring that is not already available to the conference?
- There is a high level of confidence that the assessor to be commissioned can fulfil the rationale.
Evidence for both these points should be included in the Child Protection Conference minutes. The Dorset Council process for commissioning specialist assessments, and for sharing these with at Child Protection Conferences is guidance-on-the-use-of-expert-reports-within-child-protection-conferences.pdf (proceduresonline.com) [8]
AIM3 Assessment Model – Leonard and Hackett (2019)
One example of specialist assessment is AIM3. AIM3 is an Assessment of Adolescents and Harmful Sexual Behaviour (HSB). The AIM3 model of Assessment is designed to provided practitioners with a structured framework to assist in analysing the HSB in the overall context of the young person. It is designed to be used with those young people aged 12-18 years who have committed, or where there is an evidenced professional belief that they have committed, harmful sexual behaviour. AIM3 is designed to be used not only at the initial stages following a referral, but at intervals thereafter, to assist with reviewing process being made as a result of Harmful sexual Behaviour Intervention These assessments may only be undertaken by suitably trained professionals. If you require an assessment but are not trained, you can request for one to be undertaken by discussing at Line of Sight meetings. Going forward all Advanced Practitioners will be trained to deliver this assessment alongside other practitioners who have a particular professional interest in this work. If you would like to find out more about the training, please speak with Workforce Development.
It is important to note that what can be deemed as ‘harmful sexual behaviours’ can be responsive behaviours demonstrated by children and young people that have experienced trauma, and who could have been sexually abused.
Taking legal action to protect a child
If it becomes clear to the child’s Social Worker that the child cannot be kept safe from the risk of significant harm within their current family arrangements, or if this is the decision of a Child Protection Conference, the child’s Social Worker should follow their authority’s procedures for applying for a legal order.
There is information on the range of legal orders available at Safeguarding Hub [9]
Referral to the Dorset Local Authority Designated Officer (LADO) if the adult accused of sexual abuse also works with children and young people
A professional who has been been made aware of concerns that a young person is being abused by an adult who also works with children and young people should refer to the Dorset LADO (if the child resides in Dorset) via completion of this form [10] and sending to lado@dorsetcouncil.gov.uk [11] or by phoning 01305 221122. If the child resides in the BCP Council area, then the BCP LADO should be contacted via completion of this form [12] or by calling 01202 817600. For further information on the Management of Allegations procedures please see here [13].
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