Guide to Medical Examinations in Suspected Child Sexual Abuse (CSA) Hampshire, Isle of Wight, Portsmouth and Southampton
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Guide to medical examinations in suspected child sexual abuse (CSA) Hampshire, Isle of Wight, Portsmouth and Southampton Date first created: Oct 2018 Reviewed: Jan 2020 Review due: June 2022 Contents Page 1 Flowchart: Portsmouth and SE Hants process for arranging CSA medical examinations 2 2 Flowchart: Isle of Wight process for arranging CSA medical examinations 3 3 Flowchart: Southampton and SW Hants process for arranging CSA medical examinations 4 4 Flowchart: North Hants process for arranging CSA medical examinations 5 5 How to refer summary–keeping it simple 6 6 Geographical areas covered 7 7 Medical teams contact numbers 7 8 Why should a child be referred for a medical examination? 8 9 When is a paediatric medical examination indicated? 8 10 When are DNA/forensic swabs indicated? 9 11 When might physical signs be seen? 9 12 How do we check for sexually transmitted infections? 9 13 What actions do we take to prevent pregnancy? 10 14 What consent is needed and who should accompany the child to the examination? 10 15 What happens at the examination? 11 Abbreviations used CAU – Children’s Assessment Unit CCG – Clinical Commissioning Group CSA – Child Sexual Abuse ED – Emergency Department IOW – Isle of Wight DNA – genetic material FME – Forensic Medical Examiner HIV – Human Immunodeficiency Virus MASH – Multi Agency Safeguarding Hub QAH – Queen Alexandra Hospital SARC – Sexual Assault Referral Centre STI – Sexually Transmitted Infection SE Hants – South East Hampshire SpCAMHS – Specialist Child and Adolescent Mental Health Service 1 1. Portsmouth and SE Hants. CSA Referrals Flowchart MASH/social care receive referral suspected CSA, Child aged between 0 and 15 years 364 days. Referral for medical examination must be made the same day if last possible episode of CSA was less than 1 month previously Is child intoxicated? Examination may be postponed. Contact community paediatrician and/or SARC to discuss All children under 13 years MUST be discussed with the community paediatrician on call for CSA (contact 9-5pm Mon-Sun) If urgent In office hours 8.30-5, Monday to Friday In evenings, weekends, and bank holidays If urgent medical medical attention Are forensic samples indicated? (see Are forensic samples indicated? (see attention needed page 5) page 9) needed Child taken No No Child taken to Yes to hospital Social care Social care to hospital and Is child aged 0-12 years 364 days? and referred contact contact referred to to community Yes community MASH/social MASH/social No, age paediatrician the care if not paediatrician. Social care contact care if not 13-15y next working day. already If last police who will contact already referred. possible SARC AND community referred. Social care contact police who contact Follow this episode of paediatrician (in hours) Follow this SARC. SARC FME will contact paediatrician flowchart to CSA occurred or SARC (out of hours). flowchart to to discuss whether single or joint the left for within 1 If out of hours SARC the right for examination is needed. Joint examination forensic month an will then contact forensic usual if child is under 13 years, pre- samples examination paediatrician. samples will be done pubertal, has learning problems, or has or and/or and/or the same day other vulnerabilities where paediatric community community or as soon as review might help in the safeguarding paediatric paediatric possible. process. examination examination SARC contact number: 0300 123 6616 Solent East community paediatrics safeguarding contact number: 0300 300 2013 2. Isle of Wight. CSA referrals Flowchart MASH/social care receive referral suspected CSA, Child aged between 0 and 15 years 364 days. Referral for medical examination must be made the same day if last possible episode of CSA was less than 1 month previously Is child intoxicated? Examination may be postponed. Contact community paediatrician and/or SARC to discuss All children under 13 years MUST be discussed with the community paediatrician on call for CSA (contact 9-5pm Mon-Sun) If urgent medical In office hours 8.30-5, Monday to Friday In evenings, weekends, and bank holidays If urgent medical attention attention needed needed Are forensic samples indicated? (see pg 5) Are forensic samples indicated? (see pg 9) Child taken to Child taken to hospital. No Yes No hospital. IOW Consultant IOW Consultant Social care contact Solent East Is child aged 0-12 years Social care contact paediatrician paediatrician community paediatrician. 364 days? Solent East refers to MASH/ If last possible episode of CSA occurred community refers to Yes No, social care if not MASH/social care within 1 month, examination will be Police contact age paediatrician the already referred. if not already done the same day or as soon as SARC AND Solent 13-15y next working day. If forensic referred AND possible. Police transport child and East community examination NOT adult with parental responsibility to Police contact SARC. SARC alerts paediatrician (in needed out of Portsmouth at agreed time. FME will contact Solent East Solent East hours) or SARC hours, alert paediatrician to discuss community (out of hours). If Solent East whether single or joint paediatricians. Solent East community paediatrician out of hours, community examination is needed. Joint Nurse to refers to IOW paediatrician if needed. SARC will then paediatrician the examination usual if child is accompany child IOW paediatrician arranges any contact Solent next working day. under 13 years, pre-pubertal, to Portsmouth if referrals to local sexual health services East community Nurse to has learning problems, or has needed and SpCAMHs. Children over 13 years paediatrician. accompany child or other vulnerabilities where can also be referred directly to sexual to Portsmouth if paediatric review might help health services if appropriate. needed in the safeguarding process. SARC contact number: 0300 123 6616 Solent East community paediatrics safeguarding contact number: 0300 300 2013 3. Southampton & SW Hants. CSA Referrals Flowchart 3. MASH/social care receive referral suspected CSA, Child aged between 0 and 15 years 364 days. Referral for medical examination must be made the same day if last possible episode of CSA was less than 1 month previously Is child intoxicated? Examination may be postponed. Contact community paediatrician and/or SARC to discuss. All children under 13 years MUST be discussed with the community paediatrician on call for CSA (contact 9-5pm Mon-Sun) If urgent In office hours 9-5, Monday to Friday In evenings, weekends, and bank holidays If urgent medical medical attention attention needed needed Social care or police Are forensic samples indicated? (see Child taken to Child taken to contact community page 9) hospital. hospital for paediatricians. Hospital staff Yes No medical If last possible episode of refer to attention and CSA occurred within 1 MASH/social Social Care contact police who Social care to referred to month, an examination will care if not contact SARC. SARC FME will contact MASH/ social be done the same day or as already contact paediatrician to community care if not soon as possible. referred. discuss whether single or joint paediatrician already Forensic samples will be Follow this examination is needed. Joint the next referred. done by paediatricians if flowchart to examination usual if child is working day. Follow this within forensic timescales. the right for under 13 years, pre-pubertal, flowchart to the forensic has learning problems, or has left for forensic samples or other vulnerabilities where samples and/or and/or paediatric review might help in community community theS safeguarding process. paediatric paediatric examination SARC contact number: 0300 123 6616. Solent West community paediatrics safeguarding contact number: 0300 123 6662 4. North Hants (Winchester and Basingstoke). CSA Referrals Flowchart MASH/social care receive referral suspected CSA, Child aged between 0 and 15 years 364 days. Referral for medical examination must be made the same day if last possible episode of CSA was less than 1 month previously Is child intoxicated? Examination may be postponed. Contact paediatrician and/or SARC to discuss. All children under 13 years MUST be discussed with the paediatrician on call for CSA (contact 9-5pm Mon-Sun) If urgent In office hours 9-5, Monday to Friday In evenings, weekends, and bank holidays If urgent medical medical attention attention needed needed Social care or police Are forensic samples indicated? (see Child taken Child taken to contact paediatricians. page 9 to hospital. hospital for If last possible episode ) Hospital Yes No medical of CSA occurred within staff refer to attention and 1 month an examination MASH/social Social care contact police who Social care to referred to will be done the same care if not contact SARC. SARC FME will contact MASH/social day or as soon as already contact paediatrician to discuss paediatrician care if not possible. referred. whether single or joint the next already Follow this examination is needed. Joint working day. referred. Forensic samples will be flowchart to examination usual if child is Follow this done by paediatricians if the right for under 13 years, pre-pubertal, has flowchart to within forensic forensic learning problems, or has or the left for timescales. samples other vulnerabilities where forensic 5 and/or paediatric review might help in samples paediatric the safeguarding process. and/or examination. paediatric examination SARC contact number: 0300 123 6616 North Hants paediatrics safeguarding contact number: 07787141812 Child Sexual Abuse medical referrals: summary: In-hours: Monday-Friday 9-5 Phone the paediatricians in the specialist centres: *For Portsmouth, SE Hants and IOW patients Tel 0300 300 2013 For Southampton and SW Hants patients Tel: 0300 123 6662 For North Hants (Winchester and Basingstoke) patients Tel: 0778 714 1812 * in Portsmouth, SE Hants and IOW, children aged 13-15 years needing forensic samples – contact the SARC0300 123 6616 (they may ask you also to contact the paediatricians) Out of hours + might need forensic samples (all ages) Phone the SARC 0300 123 6616.