Dr Catherine White Clinical Director St Mary’s SARC February 8th 2018 Child Sexual Abuse Medical Examinations: Car crash in slow motion or an opportunity for intervention? Dr Catherine White Clinical Director St Mary’s SARC February 8th 2018

Self and police referrals Opened Children’s SARC in 2006 1986 30,000+ clients All ages Male & female Self and police referrals Opened Children’s SARC in 2006 520 Children in 2016/17 910 Adults in 2016/17 Cover a population of 3.4 million 2 2

Integrated Service ISVA 24/7 support Live Court link Forensic medical Counselling Live Court link ISVA

All ages 2016-2017

8 Years + Child & Adult 7 questions Crisis worker Aids capacity assessment

Learning Disability UK Background prevalence 2 Learning Disability UK Background prevalence 2.5% St Mary’s SARC Adults 7.7% Children 4.3%

Mental Health Background prevalence UK 15% St Mary’s SARC 73% Estimated 15% of the general UK population has a mental health disorder (National Institute for Health and Care Excellence. (2011b). Common mental health disorders. Identifications and pathways to care. Retrieved from https://www.nice.org.uk/guidance/cg123/chapter/introduction) *Of the 180 adult clients included in the study, 73% disclosed a pre-existing mental health complaint, previous use of medication for the treatment of a mental health complaint or previous self-harm / suicidal thoughts or behaviour.

Crisis Worker Workbook Augmented reality Crisis Worker Workbook

Hub and Spoke

Dr Catherine White IAFS August 2017

Complex case review

Adverse Childhood Experiences The original ACE study dates back to 1998 San Diego. Researchers initially exploring the reasons for non attendance at an obesity clinic drew up a list of 10 adverse childhood experiences. 17,000 adults (70% Caucasian, 70 5 college educated) were screened for ACEs during routine health consultations. What they found was that ACEs are common. In fact 63.5%, nearly 2/3 will have one ACE.

Felitti VJ, Anda RF, Nordenberg D et al. 1998 Felitti VJ, Anda RF, Nordenberg D et al. 1998. ‘Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the Adverse Childhood Experiences (ACE) Study.’ American Journal of Preventive Medicine 14:245–258.

4+ ACEs compared to no ACEs IHD 2.2 COPD 3.9 Stroke 2.4 Any cancer 1.9 Ever attempted suicide 12.2 THE LONG REACH OF CHILDHOOD TRAUMA by ARIELLE LEVIN BECKER But what they found was that as an individual racks up more ACEs they are at increased risk from a myriad of problems and I have included some of the results here. Having 4 or more ACEs makes one 12.2 times more likely to ever attempt suicide. Think about Molly and her unhappy childhood. She would have had at least 4 ACEs. Her risk of suicide attempts could have been predicted years before her killed herself, offering years of opportunity to intervene. We don’t have to be merely observers in the slow car crashes that are some people’s lives. We could be agents for change. So having been exposed to such a toxic environment is a public health issue not just a social care or criminal justice problem. Removing the child, locking up the abuser doesn’t remove the downstream risk and we need to appreciate this and be proactive in our collective response. But let us return to NFS.

Model of ACE impacts across the life course Felitti VJ, Anda RF, Nordenberg D et al. 1998. ‘Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the Adverse Childhood Experiences (ACE) Study.’ American Journal of Preventive Medicine 14:245–258.

The national survey of Adverse Childhood Experiences in Wales interviewed approximately 2000 people (aged 18-69 years) from across Wales at their homes in 2015. Of those eligible to participate, just under half agreed to take part

Screening for ACEs at SARC ?

Repeat attenders Is there anything different about them? Can we prevent further victimisation?

Police? Family doctor (GP)? Court statement / report? Safeguarding?

Who else should screen? What should be done with the information?

Resilience What do we know? In the social, behavioral, and biological sciences, the term resilience is used in a variety of ways and contexts—sometimes as an individual characteristic, sometimes as a process, and sometimes as an outcome. Despite these differences, there is a set of common, defining features of resilience that illustrates how the concept has been used in research and intervention sciences. These features include the following: 1. The capacity of a dynamic system to adapt successfully to disturbances that threaten its function, viability, or development.8 2. The ability to avoid deleterious behavioral and physiological changes in response to chronic stress.18 3. A process to harness resources to sustain well-being.76 4. The capacity to resume positive functioning following adversity.77 5. A measure of the degree of vulnerability to shock or disturbance.78 6. A person’s ability to adapt successfully to acute stress, trauma, or more chronic forms of adversity.11 7. The process of adapting well in the face of adversity, trauma, tragedy, threats, or significant sources of stress.79 Whether it is considered an outcome, a process, or a capacity, the essence of resilience is a positive, adaptive response in the face of significant adversity. It is neither an immutable trait nor a resource that can be used up. On a biological level, resilience results in healthy development because it protects the developing brain and other organs from the disruptions produced by excessive activation of stress response systems. Stated simply, resilience transforms potentially toxic stress into tolerable stress. In the final analysis, resilience is rooted in both the physiology of adaptation and the experiences we provide for

Tipping the scale WWW.DEVELOPINGCHILD.HARVARD.EDU Supportive Relationships and Active Skill-Building Strengthen the Foundations of Resilience

THANKYOU @StmarysSARC @catherinewhite7 www.stmaryscentre.org Catherine.white2@nhs.net @StmarysSARC @catherinewhite7