Multi-agency response to childhood sexual abuse: a case study that explores the role of a specialist centre

Abstract

This study explores the role of a specialist centre in responding to actual or suspected childhood sexual abuse. Children, families and professionals from several agencies are required to navigate an intricate journey when abuse is suspected to have occurred. Through the application of case study research methods in which a specialist centre forms ‘the case’, the complexities of the journey are explored.
The literature review highlights the emergent nature of ‘knowledge’ about specialist children’s centres. To inform the research study, papers that focus on children and families’ experience of the multiagency response, the rate of positive medical findings on examination and their relationship with criminal justice outcomes are examined. The available literature relating to the nursing role in responding to child sexual abuse is also reviewed.
This case study comprises three data sets: 1) Sixty children (0-17 years) who attended the Centre following suspected sexual abuse were ‘tracked’ to ascertain reasons for referral, type of examination undertaken and outcomes in terms of health status, social care input and criminal justice actions. 2) Semi structured interviews with 16 professionals (paediatricians, nurses, police officers and social workers) in which their perceptions of the centre were explored. 3) Analysis of patient and parent/carer satisfaction questionnaires.
Medical examination rarely confirmed abuse had occurred and only 13% of cases were pursued within criminal justice systems. However, 66% of children had an identified health need that required professional follow up. Interviews demonstrated that professionals believed the Centre provided a ‘child friendly’ facility that enhanced multiagency co-operation, but challenges associated with the principles of multiagency working were identified. Patient questionnaires demonstrated positive views of the care received by those who completed them.
Findings from the three data sets are presented as the child’s journey through a complex series of events in a case study ‘story’. The study demonstrates the way in which professionals may be distracted by the medico-legal demands of the ‘system’.
Children’s active participation in decision making should be promoted when actual or suspected abuse has occurred and a combined approach by multi-agency professionals, based on the individual needs of each child, is advocated not only during attendance at the specialist centre but also during a follow up period. Where abuse is not confirmed, children may benefit from continued care from health professionals. Nursing has the potential to adopt a greater leadership role in achieving the required change.

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