Transcript Review of Child Sexual Abuse Services in the Eastern Region

REVIEW OF Child
Sexual Abuse (CSA)
Services in the
Eastern Region
Eastern Regional
Health Authority
October 2003
Terms of Reference
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Establish the background to the development of the
specialist CSA units
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Describe the referral process to CSA services from a
variety of agencies.
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Delineate the criteria for prioritisation in the
assessment and treatment process.
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Establish the current staffing levels and CSA unit
structures.
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Review the current waiting lists for CSA services.
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Identify possible developments for support services
for children whilst awaiting access to CSA services.
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Describe the current process for accessing
appropriate treatment services.
Referral Sources
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Referrals from Community
Care
Referrals from Hospitals
Referrals from GPs and other
professionals
Referrals from Parents and
relatives
Referrals from Gardai
Difficulties with
referral process
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Community Services
- Lack of clarity of role
- Inadequate facilities
- Training & Upskilling
- Recruitment & Retention
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CSA units
- Inappropriate referrals
- Lack of clarity on role and function
- Location at hospital site
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A&E Services
- Single- handed consultant appointments
- Lack of out-of-hours provision
- Insufficient numbers to develop expertise
Factors associated
with waiting times for
assessment
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Staff vacancies
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Complexity of cases
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Increased referrals from CCA
services
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Awaiting further information
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Training commitments
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Demands from courts
Elements of an
effective CSA Service

Provide prompt access to assessment services, in
order to identify the response and treatment
needs of the child and caregivers.
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Provide access to treatment services based on the
care needs of the child and caregivers at a time
appropriate to the child.
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Liaise and co-ordinate the care planning and
care delivery process across a number of
community and specialised services.
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Offer clearly defined referral pathways between
community, secondary and tertiary services.
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Provide services that are based on best practice
and high quality evidence.
Findings
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Lack of clarity of purpose and function of community and
specialist units.
Perceived lack of mandate at community level in
assessment function.
This lack of clarity has resulted in inappropriate referrals
to specialist units.
The absence of clear referral pathways for other referrers
and stakeholders.
Recruitment and retention issues in both community and
CSA units.
Lack of appropriate facilities in community based services
for assessment even where the teams have capacity and
expertise.
Increasing demands from the courts for specialist evidence.
Until recently A&E Consultants were single-handed in each
Paediatric Hospital and only one of three hospitals have a
paediatric on-call service.
The numbers presenting for medical examination are very
small and the opportunities for developing expertise in
medical examinations is constrained.
Key Issues
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Firstly, the need to provide an
integrated holistic service to
children and their families in
relation to all child abuse.
Secondly, the need to develop a
model of service delivery which
enables the specialist units to
deliver on their specialist,
consultative assessment and
therapeutic function.
Thirdly, the need to develop a
medical response service which
could at a very minimum provide a
24 hour medical assessment service.
Recommendations
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Agree and produce statement of purpose and
function of community and CSA units.
Clarify roles and responsibilities of each service
in the areas of assessment and therapy.
Agree and produce referral guidelines for
referral to Community services and to CSA units.
Disseminate guidelines to all stakeholders and
offer consultation and input regarding
implementation of guidelines.
Assess and prioritise vacant posts in the specialist
units.
Assess staffing needs in community services.
Develop appropriate facilities in community
services to enable assessments to be carried out at
community level.
Examine the potential for development of a single
medical response unit aimed at providing
comprehensive 24 hour medical assessment.
Implementation
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The ERHA will facilitate a detailed consultative
process during the remainder of 2003 with the
specialist and community based services.
The CSA units will initiate Consultation with
Community Services to develop best practice
guidelines.
The above consultation processes should facilitate
some immediate improvements in referral
patterns.
The ERHA will continue its liaison with the
Department of Health and Children regarding
resource requirements for this service.(priority for
2004).
The Paediatric A&E services in collaboration with
the specialist and community services will explore
the proposals for the development of a medical
response service.
Consultation with wider stakeholders regarding
referral pathways will be undertaken .