By Jane Meyrick, Michelle Cutland and Rae Adams
Child sexual abuse (CSA) is increasingly recognized and the impact often lifelong. With at least 15% of girls/young women and 5% of boys/young men having experienced some form of sexual abuse before the age of 16 years the role of sexual health is critical. Sexual health follow-up (SHFU) is offered by pediatric Sexual Abuse Referral Centers (SARCs), but a review by the clinical team at the bridge, University Hospitals Bristol and Weston NHS Foundation Trust showed we could do better. 1 in 5 were lost to follow-up, and young survivors and their caregivers found visits potentially stressful or re-traumatizing. Referral teams attempted to find an appropriate provider, especially for survivors under the age of 13 who are unable to attend standard sexual health clinics. The providers themselves reported that these consultations went beyond their day-to-day responsibilities.
Our paper describes how clinical team members supported the ‘voice group’ of survivors in Greenhouse CSA support service, to redesign a path that better meets their needs, with the guidance of a health psychologist. This work was funded by Research Capabilities funding from the NHS Trust. The work did this in a way that paid attention to power dynamics – we did not invite patients into health care structures and processes that accumulate power, but went to them. We didn’t and we started a “one-off” project-based group, but found the organizations that had already created a safe space for supported/protected survivors. The work was transformative, not because of what we did but how we did it, focusing on restoring voice and practice to young survivors whose experiences had robbed them of both. The images below illustrate the trauma- and survivor-centred passport through the sexual health tracker we developed (which included links to short “this is what it is” videos. We designed this through the arts– based, creative workshops used evidence-based tools distancing techniques allow survivors to talk safely about what others may need. Data from groups, parents and a wide range of staff were analyzed thematically.
The ‘My Healthy Journey’ map created by Dr Rachel Adams and Hope Barraclough from Bridge is for service users and their carers and clinical staff to clearly understand the journey with a parallel professional map.
The impact for those involved was “amazing”… really proud” and “The team were really pleased with the results… especially the way what they said was received and fed back… they have repeatedly said that is what makes being a part of the team worthwhile” (Vocal coordinator). We are currently formally evaluating the work, but focusing on the principles of survivors as experts by experience, we began by asking survivors how they would measure their own outcomes: as the Bridge’s Pediatric Clinical Director, Dr Michelle Cutland, wisely described it, ‘capturing clouds’ .
The theme of World Sexual Health Day this week is consent. This reminds sexual health of their crucial role in identifying and supporting survivors of a range of violence and abuse. This means moving beyond the narrow domestic violence/protection framework that can dominate. Parallel work around sexual abuse takes place with BASHH’s interest group on sexual violence. The results of a national survey of how sexual health asks about sexual and domestic violence are currently being prepared for publication, watch this space.
About the authors
Associate Professor of Health Psychology Dr Jane Meyrick specializes in sexual health and sexual violence/abuse. She recently published an accessible overview of sexual violence in her research translation #MeToo book for women and men. Her work focuses particularly on the lived experience of marginalized communities in sexual health.
Dr Michelle Cutland is the Clinical Director of the Pediatric SARC at Bridge. He is a consultant paediatrician, and recent co-clinic lead for the Royal College of Paediatrics & Child Health (RCPCH) systematic review ‘The physical signs of child sexual abuse’.
Dr Rachel Adams is a senior community and reproductive health practitioner in the South West.
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