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

5. Dr Catherine White 5 St. Mary’s Centre Core 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

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

7. 7 What is a child?

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. Dr Catherine White 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

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. Dr Catherine White 17

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

22. Domain Indicator NovDecJan92%92% Benchmark Quality and Safety ISVA Safeguarding % attendance counselling supervision 100% Re contacting : 5 working days 98% 86%95% % notes reviewed : 1 working day 100% % MARF : 1 working day98%94%96%100% MedicalAllergy documentation97.5%97%95%98% Correct HIV PEP Script100% 98% Chain of custody99%100% 98% Gaps on <13 rota7/38 (18%)6/38 (16%)7/41 (17%)<5% Gaps on >13 rota1/68 (1.5%) 4/73 (5%)< 5% Child serviceWorking days to next appointment 432.5<3 % pre pubertal Colposcopic exam 100% > 95% % marked of interest peer review 100% % DVD marked normal peer review 30% 40%>10% Training and Development Corporate mandatory training 92% 100% Clinical mandatory training 50% 100%

23. Domain Indicator NovDecJanBenchmark Centre Activity Children Total cases927998 Adults52 (56%)42 (53%)54 (55%) Children40 (40%)37 (47%)44 (45%) Children 0-1222 (55%)19 (51%)15 (34%) Children 0-1718 (45%)18 (49%)29 (66%) Acute child22 (55%)27 (73%)26 (59%) Non acute child18 (45%)10 (27%)18 (41%) All cases%Forensic Exam80 (87%)63 (80%)80 (81%) Client source%self referral15.2%21%17%> 15% % female83 (90%)74 (94%)91 (93%)< 90% % male9 (10%)5 (6%)7 (7%)> 10% % BME groups23%14%8%9% %ethnic record100%97%98% Police referrals% Police referrals84.8%79%83% % reported to policeUK CounsellingNew referrals181943 % police referral44% (8/18)10% (2/19)11.5% (5/43) Waiting list time6 wks4 weeks6 wks< 8 wks Active caseload434952 DNA rate11.2%15%9%<15%

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

32. Inter Agency Working Does it work?

33. Are the health needs met?

34. Review of statement requests January 2006 - December 2010 Total numbersStatement cases% All cases4646100822 Adults261457322% Children203243521% Females under 1367311918% Female children 13-17109326224% Male under 132034221% Male children 13-17631219%

35. Under 13s Cases 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. Dr Catherine White41 THANKYOU 0161 276 6515 www.stmaryscentre.org Stmarys.sarc@cmmc.nhs.uk Catherine.white2@nhs.net