The medical investigation as part of the assessment Andrea Goddard Consultant Paediatrician London Co-Funded by the European Union

Outline Medicolegal reasons- gathering evidence Why do a medical assessment after disclosure of/or suspected child sexual abuse? Medicolegal reasons- gathering evidence Health issues arising from the abuse General health issues Reassurance = by far the most important! Medical contribution to multi-agency planning for the child and judicial processes

My setting London Population: almost 9 million* Children under 18 years: ~ 2 million* Central acute, forensic sexual assault service ‘ The Havens’ Local services - 33 separate authorities or ‘boroughs’) Childhouse initiative in London - come to my talk tomorrow https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/datasets/populationestimatesforukenglandandwalesscotlandandnorthernireland

Medicolegal reasons- gathering evidence Forensic/DNA - swabs taken by doctors, police undertake analysis Injuries - intimate images - documentation and photography by doctors Sexually transmitted infections - tested for as part of evidence gathering (and treatment/reassurance) ? Strength of evidence base in children http://www.rcpch.ac.uk/physical-signs-child-sexual-abuse

Health issues arising from Sexual abuse Management of: Risk of Pregnancy HIV, Hepatitis B transmission STI transmission (can = evidence also)

General health and welfare issues Initial holistic health assessment E.g ? Neglect - dental caries and/or other unresolved health issues that need sorting out On going support- follow-up assessments, psychological support Contribution re health issues to multi-agency planning for the child

THE MOST IMPORTANT REASON! Reassurance that everything is normal (in > 90-95% cases of CSA in children) Child and parent often traumatised by the idea of ‘damage’ to the body Therapeutic to know from a medical assessment that all is normal - can be start of the victim’s and carer’s on-going coping with the psychological trauma of abuse N.B important to include a strong statement that ‘normal is normal’ in child sexual abuse medical assessments in medico-legal correspondence

Thank you andrea.goddard@nhs.net References: The Physical Signs of Child Sexual Abuse: An evidence-based review and guidance for best practice, 01 May 2015, Publisher: Royal College of Paediatrics and Child Health (RCPCH) 2. Sexual Assault – A Forensic Clinician’s Practice Guide. Catherine White, 2010. ISBN 978-0-9564737-0-7 3. Heger A, Ticson L, Velasquez O, Bernier R Children referred for possible sexual abuse: medical findings in 2384 children. Child Abuse Negl. 2002 Jun;26 (6-7):645-59.