Information

Supporting children and young people who may have experienced child sexual abuse - clinical pathway: consultation analysis

An analysis of the responses to the consultation on the draft Clinical Pathway for healthcare professionals working to support children and young people who may have experienced child sexual abuse.


Section 3: Clinical Pathway

Do you agree with the aims of the pathway?
Yes 40 70.18%
No 5 8.77%
Not Answered 12 21.05%
Comments
ID. Consultation comment Clinical pathways subgroup response
64HR-C Yes, but please see response provided in section 1 about the lack of detail provided about how the Clinical Pathway covers the aspects of wellbeing and recovery. The Pathway describes in broad terms what ongoing support to aid recovery should be available to Children and Young People who have experienced child sexual abuse and non-abusing parent/carer(s).
64ME-4 The aims of the pathway are to help children – but as before the method, scale and scope is inadequate. Noted
641N-H It is crucial that all approaches are clearly defined and consulted upon and that the pathway is designed to accommodate the needs and wellbeing of children and
young people. It is essential that expectations are set appropriately and that each individual knows and understands what is expected of them, and what the process will be.
It is vital that every child is treated with respect and dignity and that they are believed from the outset.
Noted
The Pathway now includes an Annex with roles and responsibilities.
The importance of taking concerns seriously is emphasised.
641K-E Our consultation group agreed that the aims of the pathway encompasses the crucial areas from disclosure through potential medical to the essential therapeutic support. However the aims state that health services “should” and there was an opinion from the group that this should be “will” be provided. If this pathway is to be successfully applied there will be significant resource implications. Currently there is a significant shortfall regarding therapeutic services for children and young people but in particular for those children under the age of 12. Our consultation group considered the children and young people we currently work with, or have previously worked with. The therapeutic supports are being provided by social work teams within our own organisation and voluntary organisations – in particular RASAC with young people over the age of 12 and their families. In some instances private providers are being approached to provide this therapeutic service. However there needs to be further discussion about who the most appropriate private providers would be if the health service is unable to provide this from their current resources. The main question being asked was in relation to who would provide the immediate and longer term support within health. The aims state “timely access” and “holistic and trauma-informed approach” but the routes into this support and how they are going to be delivered are not clear We are in agreement with the aims being nationwide and that regardless of where you live in Scotland you should expect a consistent, quality response and service. The Pathway describes in broad terms what ongoing support to aid recovery should be available to Children and Young People who have experienced child sexual abuse and non-abusing parent/carer(s).
However, the Pathway is not intended to direct the allocations of resources which are for local services to determine to support local implementation.
6412-N Dentists are likely to be involved in bullet points 1-4 to a greater or lesser extent. They cannot however participate in bullets 5 and 6 around providing trauma support or around medical examinations. There is minimal support out there for dentists to help them provide patients who have previously experienced sexual abuse or trauma with a bespoke level of care Advice received from the Children and Young People Expert Group and the Steering Group for the revised National Child Protection Guidance is that education, guidance and support on child protection is available from employers (or voluntary organisations/charities in the case of volunteers). The advice is that it not necessary and may be unhelpful to duplicate material already available in this area.
64SE-A The aims of the pathway are clear and place emphasis on the requirement for a multi-agency response to children or young people who have disclosed sexual abuse. Noted.
64SB-7 We agree with the aims stated in Section 3. We strongly support the attention in the opening paragraph to the importance of partnership working, and ensuring children (and those who care for them) are supported in a manner which promotes health, wellbeing and recovery. The references to holistic support and trauma-informed practice are also particularly positive. To improve the aims still further, consideration should be given to explicitly stating the aim of being rights-based in responses to disclosures of child sexual abuse. Additionally, explicit recognition should be given to the aim that services will be responsive, and practitioners will enable children (however they communicate) to communicate their views and needs, rather than any onus or pressure being on the child to make themselves understood. Whilst the ‘aims’ section of the document is strong, we are concerned that the stated aims and approaches are not coherently integrated into the Clinical Pathway, and therefore into practice. It is thus difficult to see how these aims will be realised. The Pathway is intended to describe best clinical practice in line with current relevant legislation and guidance. The Pathway is not intended to change the IRD or Joint Investigative Interview process or to introduce a Barnahus model or facility to Scotland. However, it is ‘Barnahus ready’ in that it could align with future development of a Barnahus model in the Scottish legal and child protection context.
The Pathway promotes consistency in Scotland across a number of areas covered by the European Barnahus Quality Standards:
  • focussing on the best-interests of the child or young person, the right to be heard and receive information and avoiding undue delay
  • multidisciplinary and interagency collaboration
  • age appropriate facilities
  • interagency case management
  • medical examination
  • the provision of ongoing support and therapeutic services for Children and Young People who have experienced child sexual abuse and non-abusing parent/carer(s).
The Pathway now has further information on how the GIRFEC approach can be used to support Children and Young People who have experienced child sexual abuse. The Pathway is to be considered an interim pathway and will be subject to review to take account of any changes to relevant guidance or legislation. It will fit in to a wider child protection context described by the revised National Child Protection Guidance for Scotland, which is currently out for public consultation.
64SH-D We would add safeguarding to the aims of the clinical pathway. This could be achieved using the following wording: “services for the child or young person and those who care for them are able to promote health, wellbeing and recovery, and maintain a focus on safeguarding.” The wording of the fourth bullet point in Section 3 (“Balance confidentiality with the need to share information to safeguard the child or young person, or other children and young people at risk of harm”) suggests an inherent conflict between confidentiality and information sharing, and may unconsciously act as a barrier to clinicians sharing information and intelligence. In our experience of working with a range of statutory partners, while confidentiality must of course be balanced with the sharing of information relating to a particular individual, agencies also hold a range of ‘softer’ intelligence, which can more readily be shared, and can be invaluable in working together to tackle child sexual abuse. For example, information on individuals of concern and places of concern can be shared. This document should leave practitioners feeling empowered to share information, rather than discouraged from or fearful of doing so. It should also be noted that where there is a child protection concern, information should be shared in order to help safeguard the child/young person, and pathways should detail whom this information should be shared with. The final bullet point in this section (“Ensure that the examination meets the forensic standards required to support any future criminal justice process including the requirement that facilities used for forensic medical examination are appropriately maintained and comply with the agreed forensic decontamination processes and procedures”) is extremely clinical/legal, and clearly places the focus on collection of evidence. There is very welcome reference in Section 6 to the fact that the primary purpose of medical examinations is to support the health and wellbeing of the child, and that the collection of forensic evidence is a secondary purpose, but that important nuance does not come across in this final bullet point. The Pathway is intended to describe best clinical practice in line with current relevant legislation and guidance. The Pathway is not intended to change the IRD or Joint Investigative Interview process or to introduce a Barnahus model or facility to Scotland. However, it is ‘Barnahus ready’ in that it could align with future development of a Barnahus model in the Scottish legal and child protection context.
The Pathway promotes consistency in Scotland across a number of areas covered by the European Barnahus Quality Standards:
  • focussing on the best-interests of the child or young person, the right to be heard and receive information and avoiding undue delay
  • multidisciplinary and interagency collaboration
  • age appropriate facilities
  • interagency case management
  • medical examination
  • the provision of ongoing support and therapeutic services for Children and Young People who have experienced child sexual abuse and non-abusing parent/carer(s).
The Pathway now has further information on how the GIRFEC approach can be used to support Children and Young People who have experienced child sexual abuse. The Pathway is to be considered an interim pathway and will be subject to review to take account of any changes to relevant guidance or legislation. It will fit in to a wider child protection context described by the revised National Child Protection Guidance for Scotland, which is currently out for public consultation.
64SU-T Not entirely- because it's aims are not clear enough. Every civilised human being in Scotland including the author never wants there to be any incidence were a child is ever raped. However, this is not well thought out. Any incidences of those 16-17 who have been raped should have not been brought into this but should have been addressed only in the adult pathway as continuously stated. It's aim should only have been with dealing with persons 15 and below. Furthermore, in regards the actual stated aims the aims state this: Aim One: " Work in partnership across agencies with a shared commitment to the best interests of the child. This includes listening to and believing the child. '' What do we mean by work with ? And what agencies ? What do we mean by the best interests of the child ? And who ultimately decides what they are ? The state ? The child ? Or the parent ? And why one over the other ? I wonder would the state believe the child if they accused a leader of one of the four constituent nations of the U.K. or would that not be believable all of a sudden ? The Pathway is relevant when providing care and support up to the age of 16 years unless there are vulnerabilities or additional needs which make it appropriate for young people aged 16 and 17.
64SU-T The biological mother, biological father or other guardian(s) other than the state are the best people to decided there child's interests. A child should always be aloud to speak and be listened to as well as having there accusation meticulously investigated but there is automatic no reason to believe the child or disbelieve them for that matter either. The accusation could be false or it could be true and believing or disbelieving them is not going to change that. The only belief that will count for that raped child is the faith in them given to them by a jury. The objective therefore should not be on motive notions such as belief or disbelief but on establishing forensic evidence. Nothing says the child has been raped by her dad more than a parental DNA match between her father and her unborn baby for example.
And nothing says a child has not been raped by her father other than a parental DNA negative result between that father & the hypothetical baby in his daughters womb either. The accused in any accusation not just rape of a child or adult is always innocent until proven guilty and should always remain anonymous until such guilt is found by a jury - the burden of proof always lays upon the accuser (in the UKs case the Crown) in any democracy and the accused has a right to know what the accusation actually is, what evidence there is to support it as well as who has made the allegation against them. Anything else can lead to injustice. I know it, you should know it and anybody purporting to have an ounce of intelligence or respect for democracy should know it.
Noted
64SU-T Aim 2: " Be focused on the reduction of further harm and promotion of the recovery of the child and family, whether or not there is an ongoing criminal justice process. '' Yes - but only with the parents consent and certainly in terms of medical recovery but if any harm reduction measures mean limiting or interfering in the life's of those accused then that should happen only in proportion to substantiated reasonable suspicion based on objective evidence and in totality only after a verdict of guilt has been found by a jury. After due process, not before. Its something you often find in western democratic nations Scotland. This is out of scope of the clinical pathway.
64SU-T " Provide appropriate and timely access to health care, emotional, mental health and social support. " Yes but only with the families consent or the alleged victims. " Balance confidentiality with the need to share information to safeguard the child or young person, or other children and young people at risk of harm. " That balance should be done in accordance to observing UKSC Judgement as given in the case of the Christian Institute and others (Appellants) v The Lord Advocate (Respondent) (Scotland) in regards all children and in accordance to s22 of the Gender Recognition Act 2004 in regards transgender people. GIRFEC should be totally dropped. Noted
64SU-T In regards risk of harm who defines what that is ? What do we mean by it ? And why ? The proposition not only states just risk of harm but possible risk of harm or in laymans terms none verified suspicion of risk of harm - there actually does not need to be a real risk of harm or harm at all. That's just a blank check to remove children from there families on a so called professionals ego trip. Unacceptable. This system equates emotional harm, psychological harm or negligence with sexual harm as if it is the one and the same issue or of the same criminal magnitude. I am sorry but there is a massive difference in a male shouting an insult at his daughter each day not attending to her needs or traumatizing her by beating up the child's mother in front of her then actually penetrating his own flesh and blood with is penis and if those proposing this can not see that then they are incapable of proportionate judgement and I dread to think what will happen to people if this is put out as some sort of magical mythical 'The SNP will fix it in every child's case'' - ridiculous. Its that kind of misequation of action that makes real victims of rape look very silly indeed and by stating the former does not in anyway mean domestic abusers should not face justice for there despicable crimes they have committed either. Noted
64SU-T " Offer a holistic and trauma-informed approach to therapeutic support '' I have no problem with this as long as its offered and not enforced. Noted.
64SU-T " Ensure that the examination meets the forensic standards required to support any future criminal justice process including the requirement that facilities used for forensic medical examination are appropriately maintained and comply with agreed forensic decontamination processes and procedures. " Yes ! Absolutely Yes ! Because that, that alone will bring justice to an incident of rape of a child for a child or of false allegation for a falsely accused adult more so than belief or none belief. Solid science not speculation, not suspicions, not politically motivated parties […] but good old fashioned scientific provable observable fact. The best tact for the prosecution in these cases is to ''get all scientific'' on the accused. Noted.
64SU-T A suspicion of child abuse about a man is no guilt of child abuse. - In a democracy he is still innocent because he most likely is. An allegation of child abuse against a man is no guilt of child abuse. - In a democracy he is still innocent because he most likely is. An arrest of a man for child abuse is no guilt of child abuse. - In a democracy he is still innocent because he most likely is. A no comment, no defence raised or non compliance in police or judicial proceedings from a man is no guilt of child abuse - In a democracy he is still innocent because he most likely is. A charge of child abuse of a man is no guilt of child abuse. - In a democracy he is still innocent because he most likely is. A prosecution for child abuse of a man is no guilt of child abuse. - In a democracy he is still innocent because he most likely is. A trial of a man of child abuse by court, media or public opinion is no guilt of child abuse- In a democracy he is still innocent because he most likely is. But An actual verdict of guilt of child abuse upon the accused man by a jury of 15 of his country persons IS guilt of child abuse in a democracy therefore when it comes him being innocence most likely he is NOT. What the state needs to guard against then is a failure in duty of a public official to investigate a complaint when requested to do so by the alleged victim or an attempt at suppression of a victims complaint or taking any side in regards the accused or accuser without evidence but merely on corruption, prejudice or assumption if this should happen the public official should both loose there job and be imprisoned for a mandatory 30 years imprisonment because there actions could either lead to an alleged victim loosing justice an a child rapist able to harm again or an innocent person being locked up for 75 years. Procurator Fiscals of yesteryear were made of much sterner stuff Scottish Government and did not have the luxury of inferring guilty into a no comment reading more so into circumstantial evidence or even take recourse to double jeopardy either back in the day a procurator fiscal had to actually think and do there job upon objective evidence and were a respected civil servant for it. The answer is not to make the standard of proof lower or less watertight in order to just satisfy a conviction quote but to equip and train Prosecutor Fiscals to be better and more skilled. Justice should be the objective hear not enforcing government policy. Inferring guilt upon a "No comment" should be abolished. Protections against double jeopardy reinstated and while an accused may have thereCadder rights the prosecution should be given more government funding to invest in more forensic services to gather more objective evidence, to concentrate on securing collaborative evidence and mounting intelligence for the prosecution of there cases. Noted.
64SD-9 [Our organisation] welcome the high level summary of the clinical pathway which retains the Interagency Referral Discussion as the core response expected by statutory agencies of disclosure of sexual abuse by a child or young person. Noted.
64SP-N We support the aims of the pathway in that it sets out how the health service is to respond to allegations of sexual abuse. This transparency helps everyone to understand the process. The requirement that the “examination meets the forensic standards required to support any future criminal justice process” is paramount. This needs to consider the issue of future proofing – preserving such evidence for future and not currently envisaged purposes, while respecting the principles of data protection and privacy. We note that the Scottish Biometrics Commissioner Bill was introduced on 31 May 2019. Account may need to be taken of its provisions in preparing the pathway The Pathway is to be considered an interim pathway and will be subject to review to take account of any changes to relevant guidance or legislation
64S1-P

[Our organisation] welcomes a reframing of the aims to ensure they reflect a truly child-centred approach. [Our organisation] welcomes aims which focus on rights, wishes, and needs of the child or young person. To achieve this [our organisation] asks for a reframing of the aims which includes a reference to listening to the child or young person, taking into account their wishes and ensuring their understanding. This reflects both the UNCRC Articles 12 and 13. As Scotland approaches the incorporation of the UNCRC into Scottish legislation, it will be critical that these pathways are reflective of this legislative and cultural change. In achieving this, [we] welcome particular consideration being given to ensuring children and young people with learning disabilities who may experience challenges in communication, are given the opportunity to have their views heard (please refer to UNCRC;1989, Article 23). [Our organisation] therefore asks that the following statements are included in the aims of the clinical pathway:

  • Listen to and take account of the wishes of the child and young person (unless these wishes place a child at risk of harm)
  • Ensure children and young people who face challenges in communication are given space, time and opportunity to make their views known
  • Ensure, where appropriate, children and young people understand the process of disclosure and forensic medical examination as well as the results and implications of their decisions.

[Our organisation] also welcomes consideration being given to ensuring children and young people experience an age-appropriate service and a clear reference to a trauma-informed approach to therapeutic support. [Our organisation] welcomes clearer guidance on what this approach means in practice. This should be expanded on in sections 4.3 in relation to trauma-informed services

The Pathway is to be considered an interim pathway and will be subject to review to take account of any changes to relevant guidance or legislation.
The Pathway now has more information and context on trauma informed care and adverse childhood experiences.
64S4-S What is the purpose and the audience? For a clinical pathway, is this about a clinical process. Is this for people who already have experience in this area of work? Consider the level this should be pitched at, and this will depend on what you include. Needs an additional paragraph: who is this for (e.g. consultants), and who is this applicable to The Pathway is intended to assist practitioners by describing best practice in line with current relevant legislation and guidance with all the relevant information in one document.
64S3-R The intention is good, and the pathway is intended to underpin wider processes. Child-centred as a whole, but depends on implementation. Ensure that the pathway highlights the pace, place and persons involved. Consider mirroring the new integrated child protection guidance, and highlight the shared principles and headline interagency principles. The aims overall fit with the new guidance. The Pathway now includes an Annex with roles and responsibilities.
The Pathway is aligned with current National Child Protection Guidance and has flexibility to take account of local multi-agency IRD procedures. The Pathway is to be considered an interim pathway and will be subject to review to take account of any changes to relevant guidance or legislation
64M5-M Section 3 is very helpful in clearly articulating the wider remit of health when caring for children who have experienced sexual abuse and their families, including the collaborative nature of the response, the promotion of therapeutic recovery and timely access to emotional, mental and social support. We would greatly welcome a clearer statement around the aim of the pathway as strengthening and improving the holistic health response to all children and young people following sexual abuse, to support the delivery of the HIS standards in Scotland. We also consider it imperative for the pathway to articulate more clearly how it relates to the HIS Standards. Our understanding is that the pathway is a tool to support services and practitioner’s to better realise the HIS standards in relation to all children and young people. In this vein, it may be helpful to reference the HIS standards in relation to specific aims. For example, HIS Standard 2 requires each NHS board to ensure that people who have experienced rape, sexual assault or child sexual abuse receive person-centred and trauma-informed care and recognises that such care is dependent on people and services working collaboratively and in genuine partnership. 2.8 of the Standard requires that support is provided to enable people to access immediate and follow-up healthcare; trauma care, including evidence-based psychological therapies; mental health services, including safety planning; sexual health services, support services, and independent advocacy. (HIS Standards, pg. 15). The pathway should illustrate the steps needed to achieve this. Bullet point 3 on the provision of appropriate and timely access to care and support should specifically reference support for both the victimised child and the family/ non-abusing carer. The response of the non-abusing carer following disclosure of child abuse and their ability to cope and respond supportively to their child, is a critical factor in the child’s recovery; the importance of supporting non-abusing carers in the treatment of children who have experienced sexual abuse has long since been recognised . Facilitating access to recovery support for both child and non-abusing carer/ family, must be a central aim of the health response to CSA. The introductory paragraph on the aims of the Pathway has been revised along these lines.
The Pathway now has more information and context on trauma informed care and adverse childhood experiences.
The Pathway describes in broad terms what ongoing support to aid recovery should be available to Children and Young People who have experienced child sexual abuse and non-abusing parent/carer(s).
Reference to the HIS Standards is made throughout the pathway (Healthcare and forensic medical services for people who have experienced rape or sexual assault standards).
64MV-N Yes, in particular the recognition that the pathway needs to be focussed on the reduction of further harm, and the promotion of recovery of the child and family. This includes recognition of the need for a wide variety of support, including trauma-informed therapeutic support. Noted.

Do you agree with the layout and content of the pathway process?

Yes 25 43.86%
No 18 31.58%
Not Answered 14 24.56%
Comments
64HR-C More useful details could be included to strengthen how the Clinical Pathway covers the aspects of wellbeing and recovery More information is now included in the Pathway.
64ME-4 As per above, the content needs to be more in line with what current research points to: the urgent need to establish a system that truly addresses the needs of the child and more comprehensive detailed training in all areas of Child Protection Noted.
The Pathway supports practitioners while training is the responsibility of employers.
64MW-P The committee agrees with all the described aims but would recommend an additional aim of: Ensure that all victims of abuse are provided with the minimum standard of care outlined in this pathway. The comment has been noted and Pathway has been revised to include the aim.
6417-T The pathway process could perhaps be extended to show medical and on-going support/therapeutic interventions. This would align with the 'holistic manner'
described at 6 - Medical Examination.
At 5.3 - JII - would be helpful to see the importance of the physical surroundings of formal interviews and the need for consistent, sensitive interview approaches
whilst gathering evidence being covered.
The Pathway describes in broad terms what ongoing support to aid recovery should be available to Children and Young People who have experienced child sexual abuse and non-abusing parent/carer(s).
Further information on JII’s is available in the revised
National Child Protection Guidance which is currently out for public consultation
641N-H While the pathway processes are clear, there seems to be an absence of support for a child (and non-abusing family) as they go through each stage. It is essential that the relevant bodies effectively collaborate with third sector organisations who may provide specialist support for children and families. In terms of aiding recovery, this additional support is crucial. The Pathway describes in broad terms what ongoing support to aid recovery should be available to Children and Young People who have experienced child sexual abuse and non-abusing parent/carer(s).
641Z-W It should include support that can be offered by the third sector throughout the process The third sector is now specifically included in the opening paragraph of the Pathway. We have not included detail in the Pathway of services offered as these vary by region and over time.
641K-E The Inter-agency referral discussion (IRD) notes advise that this is a discussion between police, social work and health but there is no reference to the inclusion of education colleagues. Although we understand that in relation to criminality and the gathering of forensic information is not the responsibility of education acknowledgement of their role is necessary. The notes also indicates that the paediatrician who is involved in the planning discussion should take the medical assessment forward. However the consultation group’s experience was that paediatricians are rarely involved at the initial planning stage. The health representatives are usually a school health nurse, health visitor or nurse advisor for child protection. The discussion with a paediatrician usually occurs following the IRD and is a separate discussion between them and
usually (but not exclusively) a police officer. Therefore clarity is required about the expectations of health regarding who is best placed to attend such IRD’s and should this be an individual who is able to make a decision regarding the need for a forensic medical?
The Pathway has been updated to reflect the language of the draft revised National Child Protection Guidance in discussing IRDs, which is currently out for public consultation.
6412-N The flowchart is a useful tool but having to refer to other sections makes it less useful as an immediate clinical tool. Noted.
6416-S As above more reference to the multi-agency nature of child protection intervention would be appropriate with specific reference to social work, education and third sector services included. This point is now emphasised in the opening paragraph of the Pathway.
64SX-W ss 5.2 - an IRD should include consideration of 'immediate safety of child and any other children living in the house' Are the last 3 words in this sentence necessary. From a contextual safeguarding perspective, shouldn't the IRD consider immediate safety of children at school and in community as well as living in the house? This is particularly relevant with respect to safeguarding concerns about adolescents. The Pathway has been updated to reflect the language of the draft revised National Child Protection Guidance in discussing IRDs, which is currently out for public consultation.
64SM-J Yes: Useful resources for further training / CPD for clinicians given Noted.
64SV-U Although we believe it could be more "user friendly". Noted.
64SR-Q Page 14 - Just a small point that the diagram is probably slightly misleading. The decisions from IRD fall into three categories, 1. Joint Investigation; 2. Single Agency Response 3. Feedback to the Named Person (for consideration of progression of wellbeing/child's plan etc) Under Joint Investigation it should be clear that the Joint Investigative interview, Child protection processes and criminal investigation (as opposed to Police Investigation) falls to BOTH police and SW as opposed to how the diagram tends to show responsibility for individual agencies (Police and SW). Whilst within a Joint Investigation Police and SW will take responsibility for different parts of it, this is absolutely a joint process. Health's requirement to conduct a JPFE or Therapeutic/Specialist Medical (various names across the country) also falls under a Joint Investigation Under Single Agency Response - this would separate out a Police Investigation from those actions that SW, Health, Education (and any other relevant agency) may be tasked with conducting from the IRD. Page 15 - 5.1 - use of the word "historic" and "historical" - these are not words that we tend use within sexual abuse investigations and probably would prefer "non-recent". 5.2 "The IRD is an interagency discussion including police, social work and health that occurs within the 24 hours after initial disclosure being received by any agency…" Suggested re-wording… "The IRD is an interagency discussion including (but not limited to) Police, Social Work and Health when it has been suspected that a child or young person has suffered, is suffering or maybe at risk of harm or abuse" Think these just highlights that an IRD is not dependent upon a disclosure from a child - it can be raised where a third party identifies significant risk of harm (whether actual or probable). Under all three headline decisions from IRD then a request for Health to undertake an examination of the child could be an option and maybe it would be helpful to make this clear? Section 5.4 The guidance is being updated but may not be ready for publication of the pathway so again a 'live' version will need updating as and when. Page 16 - There is a sentence in the first paragraph that reads… "The IRD aims to share information and identify the risks to the child (and other children in the household) so that immediate safeguarding measures can be taken" this should probably read… "The IRD aims to share information and identify the risks to the child/young person (and any other child/young person deemed to be relevant and connected to the concern) so that immediate safeguarding measures can be taken" I'm just conscious that if we are as prescriptive as children in the household, it might confuse professionals about information sharing?? The Pathway has been updated to reflect the language of the draft revised National Child Protection Guidance in discussing IRDs, which is currently out for public consultation.
The Pathway is to be considered an interim pathway and will be subject to review to take account of any changes to relevant guidance or legislation.
64SE-A The pathway process detailed in the flow chart, is in the main accurate, however, it does not include Social Work as being part of the Joint Investigative Interview (JII) process. A JII is conducted by Police and Social Work and should not be conducted as a single agency response, albeit one agency may be the lead. It would be helpful if this could be reflected on the flow chart. Inter-agency Referral Discussions are pivotal to the full process of the pathway. It is essential that the core agencies of Police, Social Work and Health consider the importance of also including education, if appropriate during IRD process as information from each agencies supports long-term and short-term decisions made in respect of a child or young person. It is vital that the IRD process is the platform to avoid single agency decision-making as this does not promote a collective response and does not always result in the best outcomes for a child or young person. Police Scotland’s approach to the IRD process has been standardised to achieve consistency in our policing roles and responsibilities to child protection. By committing to a national protocol to IRDs we hope to enhance local partnership working. The Pathway has been updated to reflect the language of the draft revised National Child Protection Guidance in discussing IRDs, which is currently out for public consultation.
The Pathway is to be considered an interim pathway and will be subject to review to take account of any changes to relevant guidance or legislation.
64SY-X Yes: Useful resources for further training / CPD for clinicians given Noted.
64SB-7 Whilst it is sometimes useful to use diagrams/flowcharts to represent complex systems and processes, in this case the process diagram fails to capture important aspects of the multiagency response to child sexual abuse. For instance, rather than a disclosure simply triggering an interagency referral discussion, importantly it should trigger support to the child and their family, in line with the Barnahus approach. Additionally, the sense of multiagency working is limited, where what is required is an emphasis on the way in which practitioners will work together to ensure children’s needs are planned for and met. Similar to other sections, the purpose of this section of the Clinical Pathway document is somewhat confusing, again giving some limited introductory information on topics such as Joint Investigative Interviewing and Interagency Referral Discussions, without constituting usable guidance. If the purpose is to place the medical examination in context, this could be better achieved with greater emphasis on matters such as interagency collaboration and support to children and their families. Therapeutic support helps rebuild children’s lives by helping them to understand and move on from difficult experiences. The response of non-abusing parents and carers is critical to children’s recovery, and this must be reflected in the planning and provision of support from multiagency partners. (10) In relation to the detail of the stages outlined in the diagram, it is concerning that the ‘Management of Healthcare Needs’ stage receives limited attention. This is an important and complex stage of the process, where multiagency plans to meet assessed need should be made and implemented, in line with the Girfec approach. The reader is referred to Section 6 for more information on ‘follow up’ from the medical examination, however the content of section 6 which relates to ‘follow up’ is very limited, focuses on processes, and fails to reflect any sense of the trauma-informed, child-centred approach the Clinical Pathway sets out to aim for. Section 5.2 refers to Interagency Referral Discussions (IRD). Whilst the document sets out an overview of the IRD process, it is important to note that there is significant variance in IRD practice across Scotland. The current National Guidance for Child Protection in Scotland (2014) does not contain guidance on IRDs, however this will be encompassed in the reviewed guidance, to be published in 2020. (10) Galloway, S., Love, R. & Wales, A (2017) The Right to Recover: Therapeutic services for children & young people following sexual abuse - An overview of provision in the West of Scotland. NSPCC Section 4: Medical Examination 1 Do you agree with the medical examination The sections on IRD, JII and support for Children and Young People who have experienced child sexual abuse and their non-abusing parent/carer(s) has been updated. The Pathway has been updated to reflect the language of the draft revised National Child Protection Guidance in discussing IRDs, which is currently out for public consultation.
The Pathway is to be considered an interim pathway and will be subject to review to take account of any changes to relevant guidance or legislation.
64SZ-Y The layout is accessible, albeit much of the key information needed is in the attached links. Re content see below for specific comments: Page 2. Paragraph 8. Throughout the document the term child sexual abuse is used. This should be changed. p.8 you reference stats from England around prevalence and say “The Crime Survey for England & Wales (2016) reported that 10.5% of women and 2.6% of men had experienced any form of abuse; 3.4% of women and 0.6% of men had experience of penetrative offences.” When you reference ‘abuse’ do you mean all kinds of abuse eg emotional and physical abuse or is this shorthand for sexual abuse? Important to be clear. On page 8 the paper also references the increase in reports of sexual crime reporting by young people and state “There is an increasing trend of police recordings over the past 5 years, but the reasons for that trend cannot be identified with certainty.” Whilst this is true I think 2 issues are important to include here. Firstly (which is mentioned elsewhere) that the vast majority of reports are historic and outside the forensic window, and that even where forensics or child protection are not concerns that there should still be an onus to consider the wider and longer term mental and physical health needs of the person disclosing. It is also important to include the number of young people where cyber enabled sexual crime is an issue – the threatening and/or sharing of intimate images. This is often minimised and young people blamed but image based abuse can have significant impacts on the wellbeing of the young person as evidenced in this new research https://www.dur.ac.uk/resources/law/ShatteringLivesandMythsFINALJuly2019.pdf For this reason the legislation for this should be included in the document about legal content. On page 9 you use the term ‘allegedly’ here: “ Cases are counted in the year that the case was concluded rather than when the crime was (allegedly) committed. “ I would suggest this term should not be used anywhere as it implies dubiety of the veracity of the disclosures, which is not the role of health. Not being believed is one of the biggest barriers to disclosure and modelling the best practice in language we can for all health professionals is what this document should aspire to. Police Scotland have moved away from this terminology and instead talk of the far more neutral ‘reports. You could say something else like: Cases are counted in the year that the case was concluded rather than when the crime was reported to have taken place. On page 12 you reference the NHE Education Opening Doors trauma informed practice resource. It would be worth including the Sowing the Seeds one which is about trauma informed practice with children & young people https://vimeo.com/334642616 On page 13 you talk about checking whether under age sexual activity is truly consensual and “ to ascertain if this activity is truly consensual and ensure the child is not a victim of exploitation or grooming.” It would be helpful if coercion could be added in there. Again I think that the adolescent experience might be missed as grooming and exploitation implies more of an age/power dynamic than some of the more subtle coercive behaviour which could be missed in a more peer to peer abusive situation. On page 14 Do all disclosures need an IRD? What about a 15 year old who was raped on holiday, who has a supportive family, and who doesn’t want to report to the Police. What role would social work and the Police have? It would be appropriate to consider support needs by the health care professional eg Look at sexual health and/or referral to rape crisis, but what actions would statutory services take? Whilst this is high level and would apply to many cases if this is too black and white it risks services providing support to young people having no confidentiality and having to disregard the young person’s choice, for the 13-15 age group, when specialist agencies will be risk assessing and reviewing child protection and risk constantly. Compared with the much more holistic and collaborative adult pathway this seems like a poor sister. The term “Management of health care needs” for example, unlike the assessment and referral protocols and pathways around psycho social physical and mental health care needs for adults. On Page 15 again the term allegation is used in paragraph 4 which is unhelpful and has a hint of disbelief, which would be picked up by survivors & family members if used by professionals. This would be better replaced with the neutral term disclosure in this context. On page 15 the list re presentingsymptoms, the last one is not the same format, eg a perpetrator of abuse. Page 15 When referring to child protection the paper highlights assessing: “ Immediate safety of child and any other children living within the house.” I would suggest removing ‘in the house’ and say ‘who may be at risk’. The existing phrasing limits the risk and setting to the family home and the risks may be outwith that, eg in the wider family, care setting, a school etc. Page 16. Paragraph 2, also names the household : “The IRD aims to share information and identify the risks to the child (and other children in the household) so that immediate safeguarding measures can be taken.” Again I would suggest that ‘in the household’ is removed so that this is considered beyond a single family setting. Page 17. As highlighted earlier re the Child’s Plan you state “The Child’s Plan (GIRFEC) may include access to ongoing therapeutic support for the child and their family members / carers post examination, but also in the months and years following disclosure of Child Sexual Abuse (CSA).” This is one of the key areas for improvement in the current system. This should be much more of a feature. There is reference to work in the taskforce considering this but the intention should be clear. I would suggest this should be changed to something along the lines of: “The Child’s Plan (GIRFEC) SHOULD ALWAYS CONSIDER THE NEED FOR access to ongoing therapeutic support for the child and their family members / carers post examination, but also in the months and years following disclosure of Child Sexual Abuse (CSA).” This cannot be overstated. The figures in the Pathway are provided for context only. The primary aim of the Pathway is to promote the delivery of consistent high quality care and support to Children and Young People who have experienced child sexual abuse and their non-abusing parent/carer(s).
The language in the Pathway is aligned with the draft revised National Child Protection Guidance. It now includes cyber enabled abuse.
The Pathway now has further information on how the GIRFEC approach can be used to support Children and Young People who have experienced child sexual abuse.
The Pathway is to be considered an interim pathway and will be subject to review to take account of any changes to relevant guidance or legislation.
The Pathway describes in broad terms what ongoing support to aid recovery should be available to Children and Young People who have experienced child sexual abuse and non-abusing parent/carer(s).
64SH-D As noted in Section 1, Question 1, we believe that coordinating pathways should be developed for children and young people who have disclosed ongoing abuse; children and young people who have disclosed non-recent or non-current abuse; and children and young people where sexual abuse is suspected. We also believe that the pathway should apply to all children and young people under 18. If it is the case that the guidance remains for those under 16 (or up to 18 for young people with vulnerabilities and additional support needs), it is essential that the guidance signposts to support for 16/17 year olds. Simply treating young people who have been through this experience as adult abuse victims is not sufficient. The pathway would be strengthened by focussing more on support for the child/young person. At present, support for the child is not included until the very end of the pathway at Section 5.5, but we believe that it should be a consideration from the outset. One important element of this is that the pathway must include a step between disclosure and IRD where the medical practitioner considers whether or not the child/young person is currently safe (for example whether they are leaving the appointment with the perpetrator), and if not, supports the practitioner to know how to take steps to help to secure the child/young person’s welfare. In order to ensure that medical staff are equipped to provide support, additional guidance on how to respond to a disclosure (expanding on the useful ‘listen and believe’ message) could be included in this document. It should also further detail (prior to IRD) who professionals should contact in the first instance, how arrangements for an IRD are made, and any relevant timescales for doing so. It would also be useful for the pathway to include consideration of what role the medical practitioner is able to play in providing ongoing support to the child or young person. If the child or young person has chosen to disclose to a medical professional, this could be because they feel they can trust them, or feel a connection with them, so in some cases an ongoing supportive relationship could be extremely beneficial. While this is more likely to be appropriate/possible in some contexts than others (for example, school nurses), all medical professional should be encouraged to consider a follow-up appointment. As noted in Section 1 above, we believe that the pathway could be strengthened by considering how children and young people can be more involved in the process. The language and processes in Section 5.2 could be revised to assist with this. For example, seeking the child/young person’s views on, and consent to, a medical examination should come before decisions about the type or location of the examination. We welcome mention in the pathway of support for those around the child, and would be pleased to see this section expanded and strengthened with the outcomes of the work being taken forward by the Taskforce. Making support available to non-abusive carers and family members to better respond to their child’s needs was found to be a key component of a child’s recovery by the NSPCC’s ‘Right to Recover’ work in 2017 (https://learning.nspcc.org.uk/research-resources/2017/right-to-recover-sexual-abuse-west-scotland/) Barnardo’s colleagues in England recently conducted research into the needs of young victims and witnesses involved in criminal justice processes relating to CSA and the practical and operational considerations of undertaking this kind of work within a multi-agency environment. Five elements were identified as being central to helping children and young people to cope with the emotional stress and turmoil they can experience, and help set them on a pathway to recovery. These were: sense of self and control; relationships and support networks; emotional and physical health; practical support; and safety and safeguarding. This may be a useful framework from which to promote a holistic, child-centred response from medical practitioners. (https://www.barnardos.org.uk/journey_to_justice_summary_paper.pdf) The Pathway is to be considered an interim pathway and will be subject to review to take account of any changes to relevant guidance or legislation.
The Pathway describes in broad terms what ongoing support to aid recovery should be available to Children and Young People who have experienced child sexual abuse and non-abusing parent/carer(s).
64ST-S Too simplistic and does not reflect the nature of sexual abuse - most cases will not fit into a nice simple flowchart and this should be acknowledged. Noted.
64SU-T For many reasons the primary being proscription of abortifacients that would be used to abuse another child in the womb by killing them. Two wrongs don't make a right. One can not stop abuse towards a child by killing another child in that case you are only left with one dead baby and a dead mothers soul. There are also other inherent dangers hear for both a real victim and a real falsely accused person concerning the planned system to be perfectly honest and I don't think the Government in those cases would honestly care as long as there safe and there public policy looks as if its working. Noted.
64SD-9 [Our organisation] welcome the high level summary of the clinical pathway which retains the Interagency Referral Discussion as the core response expected by statutory agencies of disclosure of sexual abuse by a child or young person. [Our organisation] notes the on going work of the Chief Medical Officer Taskforce and the intention to legislate for self referral. Although it is expected that any legislation will take account of the need to manage any disclosure by a child or young person as a potential child protection concern, for the avoidance of doubt the pathway should include guidance for practitioners is circumstances where a child or young person attempt to self referral. Members of the CYPEG worked collaboratively with the child protection Managed Clinical Networks and third sector parties to develop a short, accessible leaflet specifically aimed at young people who may undergo an examination. It sets out what young people can expect both during and following the process as well as providing sources of support.
In addition to the leaflet for young people we are producing an Easy Read version of the forensic medical examination process. We will review the use of this product and the leaflet for young people when undertaking any future revisions and will consider further accessibility requirements at that point.
65SQ-P

There are significant inaccuracies in section 5, both in the illustrated flowchart and subsequent text. The diagram:

  • The flowchart diagram is both inaccurate and confusing.
  • Joint investigative interviews are a joint social work and police activity and the diagram should reflect this.
  • Child protection processes involve all agencies and not solely social work as indicated in the diagram
  • We suggest that placing the box ‘Inter-agency child protection procedures’ at bottom of the diagram is misleading as these procedures govern the whole process and not just the end point.

It may be more helpful to say ‘multi-agency support to protect the child and promote their wellbeing’ as this would capture the GIRFEC approach whatever the outcome of the child protection enquiry

The Pathway has been updated to reflect the language of the draft revised National Child Protection Guidance, which is currently out for public consultation.
The Pathway is to be considered an interim pathway and will be subject to review to take account of any changes to relevant guidance or legislation.
It will fit in to a wider child protection context described by the revised National Child Protection Guidance for Scotland, which is currently out for public consultation.
64SQ-P

Para 5.1:

  • There is no mention of young people aged 16 and 17 years and the response required for those in this age group
  • There is no mention in the bullet points or text of child sexual exploitation, how this may present, and the multi-agency response required
  • Bullet point 3 – it may be helpful to include episodes of running away or going missing as a key behaviour likely to raise concerns about a child or young person Para 5.2:
  • While the guidance sets out the areas for consideration by those taking part in an initial referral discussion (IRD), the purpose of the IRD i.e. to ensure co-ordinated inter-agency child protection processes up until the point of child protection case conference (CPCC) is held or until a decision is made that a CPCC is not required, is not clear. The areas for consideration refer up to the point of investigation/examination rather than beyond this, such as the health contribution to the initial risk plan.
  • It may be more helpful to state that an IRD should take place as soon as possible after disclosure and in accordance with local child protection procedures than to specify a timescale. Para 5.3:
  • The description given of the joint investigative interview does not sufficiently reflect this activity. It may be more helpful to use the definition set out in national guidance ie “the purpose of joint investigations is to establish the facts regarding a potential crime or offence against a child, and to gather and share information to inform the assessment of risk and need for that child” ( National Guidance for Child Protection in Scotland, 2014, p.89).
  • We suggest removing the heading ‘Police investigation’ as the feedback to the IRD is a joint activity and not police only
The Pathway is to be considered an interim pathway and will be subject to review to take account of any changes to relevant guidance or legislation.
It will fit in to a wider child protection context described by the revised National Child Protection Guidance for Scotland, which is currently out for public consultation.
CSE is now mentioned within the Pathway.
The Pathway has been updated to reflect the language of the draft revised National Child Protection Guidance, which is currently out for public consultation.
64S1-P

In Franklin et al’s research regarding sexual exploitation children and young people with learning disabilities, the authors were able to identify significant barriers which stopped children and young people disclosing sexual exploitation. The children the authors spoke to recounted:

  • Not feeling able to tell their social worker because of a lack of trust
  • Having difficulties understanding the questions being asked of them
  • Not understanding they are or were being abused
  • Not having reports of abuse believed.

The authors stated that when disclosure did occur it usually only happened after a long time when a positive and trusting relationship was built with a professional. The same research raised concerns regarding a lack of professionals enquiring about the sexual exploitation of the children and young people they support. The authors stated, “The evidence gathered in this study also indicates that adults, including professionals, are not proactively identifying potential signs of exploitation, thus placing an incredible burden on young people with learning disabilities to disclose they have been sexually exploited, and therefore to have an understanding of and recognise, their own sexual exploitation”. (Franklin et al; 2015, p.132) In considering this, [our organisation] welcomes part 5.1 ‘Disclosure by a child/ young person’, giving in-depth attention to some of the barriers children and young people may face in disclosing sexual exploitation and abuse. The guidance should then make reference to a number of approaches and tools which may help a person to disclose. This could include the routine inquiry form produced by CKUK and Central Sexual Health. You can view this resource here. This form provides a tool to help professionals to ask people with learning disabilities about things like relationships, sex and also abuse. This form is being used as part of NHS Health Scotland's Guidance about learning disabilities and gender-based violence. In addition, visual tools to prompt conversations on different types of abuse may be helpful. For example, the ‘blob image on abuse’ which can be accessed here. To support this type of discussion with individuals who may communicate non-verbally, [our organisation] requests the use of Talking Mats Keeping Safe Resource. Information about this can be found here. In terms of helping practitioners to understand if they may need to have a conversation with a child or young person regarding sexual abuse or child sexual exploitation, the following ‘Child Sexual Exploitation – Potential Indicators' Tool used in South Ayrshire may be a helpful resource. This can be accessed here. [Our organisation] welcomes the use of all aforementioned tools as part of the pathway and should be provided to professionals and practitioners alongside the document (please refer to Recommendation 5). [Our organisation] would welcome the opportunity to develop this training if required. While [our organisation] welcomes the role of the types of aforementioned tools to support children and young people with learning disabilities to disclose sexual abuse, [we] believes there is also a wider issue regarding the appropriate provision of Relationship, Sexual Health and Parenting Education for children and young people with learning disabilities, which requires further attention outside the remit of this response. Following a disclosure of abuse, [we] believes that it is critical that the pathway ensures professionals recognise the importance of children and young people understanding all there options regarding medical examinations and prosecution of offenders. To achieve this all information will need to be developed in a variety of formats including easy-read

More on the vulnerability of disabled children and young people to all forms of abuse is now included. There is more on taking consent for examinations/information sharing etc in the Pathway with hyperlinks to more detailed guidance if required.
The Adults with Incapacity Act and the Adult Support and Protection Act are now included within the pathway for consideration when appropriate. The limits to confidentiality when the person or others are considered to be at risk of ongoing harm are now included.
The Pathway makes provision for young people aged 16 and 17 with additional vulnerabilities to be included within its remit including the use of child protection procedures if appropriate. It also provides guidance on the appropriate approach to young people aged 16 and 17 where the provisions of the Adult Support and Protection (Scotland) Act 2007 may be appropriate. The Pathway advises practitioners that for particularly vulnerable young people aged 16 and 17 (and potentially up to 25 years if care experienced), that although the young person is on the adult pathway, the requirements of public bodies related to corporate parenting and/or Getting It Right For Every Child (GIRFEC) must be considered.
64S1-P Ensuring children and young people understand their choices and options For all children and young people with learning disabilities, there is a potential power imbalance in dealing with adult professionals. In ‘UnderprotectedOverprotected’ (2015) the author’s stated that, “The evidence highlights that protecting children and young people must start with the basics of listening to them and providing early support to prevent exploitation.” (Franklin et al; 2015, p.135) However, potential power imbalances between professionals and children and young people with learning disabilities may lead to children and young people’s voices being lost. There is also a risk that the way information is framed when given to people with learning disabilities, may limit their choice and control in decision making. In [our] earlier response to the Scottish Government [we] stated that due to perceptions of vulnerability of people with learning disabilities, well-meaning professional’s shielded critical information from people with learning disabilities. This response stated: "Shielding people with learning disabilities from information deemed ‘unsuitable' denies them the opportunity to make informed decisions. Without the provision of accessible information which is articulated and understood, it is difficult to ensure a person has come to their decision based on an understanding of the outcome. Even when a professional is not actively withholding information individual challenges can occur as a result of unclear and non-explicit communication.” To counter this, [our organisation] asks that the guidance provides suggestions for the provision of accessible information in a range of formats. Moreover, the guidance should outline the role of advocacy for children and young people with learning disabilities More on the vulnerability of disabled children and young people to all forms of abuse is now included. There is more on taking consent for examinations/information sharing etc in the Pathway with hyperlinks to more detailed guidance if required.
The Adults with Incapacity Act and the Adult Support and Protection Act are now included within the pathway for consideration when appropriate. The limits to confidentiality when the person or others are considered to be at risk of ongoing harm are now included.
The Pathway makes provision for young people aged 16 and 17 with additional vulnerabilities to be included within its remit including the use of child protection procedures if appropriate. It also provides guidance on the appropriate approach to young people aged 16 and 17 where the provisions of the Adult Support and Protection (Scotland) Act 2007 may be appropriate. The Pathway advises practitioners that for particularly vulnerable young people aged 16 and 17 (and potentially up to 25 years if care experienced), that although the young person is on the adult pathway, the requirements of public bodies related to corporate parenting and/or Getting It Right For Every Child (GIRFEC) must be considered.
64S1-P

[Our organisation] believes there is a need for the clinical pathway to ensure that accessible information about what happens when you disclose abuse, as well as your choices following disclosure, is provided in appropriate health care settings. [Our organisation] recommends that, as a starting point, easy read documents outlining both the disclosure process and options following disclosure should be created. An additional easy read document about what happens during a forensic medical examination should also be provided. As an example, [our organisation] points to a four-part easy read guide published by Learning Disability Wales for parents with learning disabilities. See below:

  • Your rights when you are pregnant
  • Your rights when your baby is born
  • Your rights with social services
  • Your rights when your child is taken away [our organisation] recommends that as part of the development of the clinical pathway the Scottish Government works with NHS Health Scotland and third sector partners (for example Values into Action Scotland) to produce similar documents.

These documents should outline children and young people's rights when they disclose and their rights in regard to forensic medical examinations. These guides can be used with all children and young people and should be widely available. For children and young people who face challenges in literacy, supporting videos should be made. These videos should include BSL and Makaton. Brail versions of the easy read should also be widely available

The Taskforce is working with the child protection Managed Clinical Networks to develop guidance specifically aimed at young people who may undergo an examination.
64S1-P [Our organisation] believes there is an important role for advocacy services in supporting children and young people with learning disabilities who have experienced rape and sexual assault. Following disclosure, [our organisation] believes the first stage should be an offer of timely advocacy provision. The role of the advocate should be to ensure the child or young person fully understands their circumstances and the outcomes of any of their decisions. This could counter the potential amenability of children and young people with learning disabilities, who at times are taught compliance as good behaviour (Wescott; 1991) [Our organisation], therefore, requests the provision of independent child and young people’s advocacy to ensure children and young people are supported to make their voices heard. In line with [our] earlier response to the Scottish Government, [our organisation] believes this will support commitments to the UNCRPD and The Mental Health (Care and Treatment) (Scotland) Act (2003) . As [we] stated, “Ensuring advocacy provision as part of this process for people with learning disabilities will meet a commitment to Article 12 of the UNCRPD as well as The Mental Health (Care and Treatment) Act (2003) which provides a legal right to advocacy for people with learning disabilities and places a responsibility on local authorities and health boards to take ‘reasonable steps’ to ensure individuals are informed about advocacy services, their remit and how to access these services” (SCLD; 2019, p.13) Moreover, [our organisation] believes that a commitment to provide advocacy to children and young people will also support the realisation of Article 12 of the UNCRC which says that, “States Parties shall assure to the child who is capable of forming his or her own views the right to express those views freely in all matters affecting the child, the views of the child being given due weight in accordance with the age and maturity of the child” (UNCRC; 1992, p.5) In understanding The Scottish Government’s commitment to embed the UNCRC principles into Scottish legislation and policy and the ongoing work in this area, SCLD would ask that provision of advocacy for children and young people who have experienced rape and sexual assault be included in this guidance. This can be supported with links to advocacy organisations who could provide this service. More on the vulnerability of disabled children and young people to all forms of abuse is now included. There is more on taking consent for examinations/information sharing etc in the Pathway with hyperlinks to more detailed guidance if required.
The Adults with Incapacity Act and the Adult Support and Protection Act are now included within the pathway for consideration when appropriate. The limits to confidentiality when the person or others are considered to be at risk of ongoing harm are now included.
The Pathway makes provision for young people aged 16 and 17 with additional vulnerabilities to be included within its remit including the use of child protection procedures if appropriate. It also provides guidance on the appropriate approach to young people aged 16 and 17 where the provisions of the Adult Support and Protection (Scotland) Act 2007 may be appropriate. The Pathway advises practitioners that for particularly vulnerable young people aged 16 and 17 (and potentially up to 25 years if care experienced), that although the young person is on the adult pathway, the requirements of public bodies related to corporate parenting and/or Getting It Right For Every Child (GIRFEC) must be considered.
64SK-G P14 The pathway in green box states 'management of healthcare needs' but the rest of the document and supporting information talks about health and wellbeing needs--needs to be consistent as there are subtle differences..page 18 states the purpose of the medical examination is about health and wellbeing needs so green box should mirror this Now revised.
64S3-R The diagram reflects the IRD process. Interviews between police and social work are always joint, and need to check this is reflected in the diagram. The diagram implies that the child protection procedures don't apply until further down the pathway, after the IRD. Child protection procedures usually apply from the moment a concern is raised. The Pathway has been updated to reflect the language of the draft revised National Child Protection Guidance, in discussing IRDs.
The Pathway is to be considered an interim pathway and will be subject to review to take account of any changes to relevant guidance or legislation. It will fit in to a wider child protection context described by the revised National Child Protection Guidance for Scotland, which is currently out for public consultation.
64S4-S Need a brief summary about why each document that is hyperlinked is relevant for each section. Although it is a short document, people may feel they'd missed out if they don't read all associated documents, and get caught up in clicking through additional documents. The Pathway is intended to supplement existing national guidance and standards, highlighted in section 1. Hyperlinks are provided throughout the pathways for all resources referenced or referred to in the document.
64S4-S Illustrations are very useful. Need to make the support and onward forward support section clear within the trauma-informed model. Narrow focus, as there is not enough focus on family support The Pathway describes in broad terms what ongoing support to aid recovery should be available to Children and Young People who have experienced child sexual abuse and non-abusing parent/carer(s).
64S4-S No real involvement of CAMHS in the flow-chart, when they are an important agency. Noted. Mental health is now mentioned rather than CAMHS which may not be the necessary service in every case.
64S4-S In our research, consultants rarely attended case conferences. May get a health visitor or a school nurse, once or twice a GP, but the initial decision-making is not usually benefiting from the discussion involving health. Noted.
64S4-S At the moment, it looks so siloed---police have one role, social work another, health another etc. This does not reflect where we are going and how this shared responsibility works in practice. A web of support around the child should be reflected, rather than a linear process. The Pathway has been updated to reflect the language of the draft revised National Child Protection Guidance, in discussing IRDs.
The Pathway is to be considered an interim pathway and will be subject to review to take account of any changes to relevant guidance or legislation. It will fit in to a wider child protection context described by the revised National Child Protection Guidance for Scotland, which is currently out for public consultation.
64S4-S IRD process as it is detailed is not often how it happens and doesn't give an accurate representation. Lothian has a flow-chat which puts the IRD in the centre in a way this is more accurate The Pathway has been updated to reflect the language of the draft revised National Child Protection Guidance, in discussing IRDs.
The Pathway is to be considered an interim pathway and will be subject to review to take account of any changes to relevant guidance or legislation. It will fit in to a wider child protection context described by the revised National Child Protection Guidance for Scotland, which is currently out for public consultation.
64MW-P One minor point, would be to lengthen the line to the Health box to visually show that this involvement will come both at the IRD and then after an initial Police and Social Work investigation The diagram has now been revised and has a different layout.
64MV-N The diagram on page 14 of the document, despite the aim of the pathway being (as stated on page 10) promotion of recovery of the child and family, makes no mention of recovery or therapeutic support for the child or family. The end point of the pathway is child protection, not the ongoing recovery of child and family. If the aim of the pathway is reduction of further harm, and the promotion of recovery of the child and family (as stated earlier in the document) this need to be central to the diagram on page 14. [We] believe that recovery should start at the point of disclosure, so this should be a central feature of the diagram. The third paragraph of section 4.5 draws a distinction between consensual and non-consensual sexual activity. However, it would be important to clarify in this paragraph that, as previously highlighted, the National Child Protection Guidance states that “Sexual abuse is any act that involves the child in any activity for the sexual gratification of another person, whether or not it is claimed that the child either consented or assented”, so even where a child claims to have consented to sexual activity an offense has taken place and child sexual abuse has occurred The Pathway describes in broad terms what ongoing support to aid recovery should be available to Children and Young People who have experienced child sexual abuse and non-abusing parent/carer(s).
The Pathway has been updated to reflect the language of the draft revised National Child Protection Guidance.
64MV-N As previously stated [we] ultimately believe that ensuring children and young people who disclose any form or abuse or harm get a holistic, multi-agency and trauma informed approach is best achieved through the development of the Barnahus standards for Scotland, and this pathway needs to be considered within Barnahus processes and context. The Pathway is ‘Barnahus ready’ in that it will facilitate the introduction of a Barnahus model in the Scottish legal and child protection context.

Contact

Email: CMOtaskforce.secretariat@gov.scot

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