Galway leading the way in child sexual assault treatment

Galway has become the first city in the State to offer a 24-hour treatment service for children who have been sexually abused – and aims to become the first to provide advocacy services for children caught in this situation.

A new pilot programme supported by the Manuela Riedo Foundation Ireland and Children at Risk in Ireland (Cari) will shortly advertise for 10 suitably qualified volunteers who will train in advocacy to support children and their families in the aftermath of abuse – right up to and including court hearings.

Currently, Galway is also the only city in the State to have co-located sexual assault treatment services for children, adolescents and adults, and it has also established a paediatric training position in forensic child sex abuse.

Pioneering partnership
The developments are in no small part due to a pioneering partnership between paediatrician Dr Joanne Nelson and the foundation, which was established by the parents of Swiss teenager Manuela Riedo in the aftermath of her violent death in Galway in 2007, along with support from the Health Service Executive (HSE) West.

It was a chance move to the west of Ireland from the North by Dr Nelson that influenced the developments at a time when, as Dr Maeve Eogan, director of the Rotunda's Sexual Assault Treatment Unit (Satu) in Dublin, puts it, "a 33-year-old abuse victim had more chance than a three-year-old abuse victim of receiving standardised care".

In spite of four major reports on clerical child sexual abuse – Ferns, Murphy, Ryan and Cloyne – there has been a very patchy system of support for paediatric cases, with “some excellent pockets and some far less-developed areas of care” for victims of sexual abuse under the age of 14 years, says Dr Eogan, who is also director of the national Satu network.

Dr Nelson had been lead paediatrician for child protection in North and West Belfast before she moved to Galway with her husband and family in 2008. She approached the HSE West Child Care manager to offer her services on the rota for treating child sexual assault cases – only to find there was no rota, and that the only service was a voluntary one offered by gynaecologist Dr Roger Derham located in the Bon Secours Hospital.

Slow response
The HSE West suggested that she and Dr Derham draw up a business plan – but as the recession had just hit, the response was initially slow.

In late 2010, facilities and equipment were put in place so that a new child and adolescent sexual assault treatment service could co-locate with the existing adult Satu at Ballybrit, and the HSE West committed funding for staffing from April 2011.

In 2011 the Child and Adolescent Sexual Assault Treatment Service (Casats) in Galway handled more than 50 cases, 77 cases in 2012 and 55 cases to date this year.

It follows British Faculty of Forensic and Legal Medicine guidelines for best practice, as there are no standardised Irish guidelines as yet.

Young victims of sexual assault require very specialised skills, as children often don’t report an assault immediately and paediatricians with forensic training have to look for “very subtle” physical signs of healing, along with psychological signs, Dr Nelson explains.

While the co-located services work well, particularly for 14- to 18-year-old abuse victims who could fall into either age category, there is only one clinical examination room. “It means that if an adult and paediatric case coincide, one case has to be diverted,” Dr Nelson says. “Our wish list is that we would have two clinical forensic rooms, along with a third room for ‘cold’ [historical] cases, with separate entrances and waiting areas for each.”

The pilot child advocacy programme in Galway is based on the child liaison officer model offered at St Mary’s Sexual Assault Referral Centre in Manchester, one of the leading forensic, counselling and aftercare services for both adult and child victims of sexual assault in Britain, Dr Nelson explains.

“Adults, as in 14 years old and up, who are seen at any one of the six sexual assault treatment units across the State are offered rape crisis centre support from a trained volunteer at the time of forensic medical examination, and can then receive counselling and psychological aftercare,” she says. “However, there are very limited services for children.”

“Our pilot advocacy programme for children and their families would provide a trained person who is present at the forensic examination, and who links in with the family to provide longer term support services for the child up to and including any court hearing,” she says.

“The people we train will have had to have experience in child care or social care, may have a psychology degree, counselling qualification or equivalent and be Garda vetted,” she explains. “We would hope to have the child advocacy service up and running by next summer.”

Exemplary model
Dr Eogan says that the Galway model is "exemplary" in terms of the support it is already offering to children from six western counties on a 24-hour, seven-day-a-week basis. She pays special tribute to the parents of Manuela and co-founders of the Manuela Riedo Foundation Ireland, Hans Peter and Arlette, for their remarkable contribution towards improved services for victims of assault and abuse in Ireland.

“Their foundation has supported this new service for children in Galway, it is contributing to rape crisis centres, and it has also paid for an annual educational study day which involves staff from rape crisis centres, sexual assault treatment units, the Garda and others and which is invaluable in sharing expertise,” says Dr Eogan.