Methods of diagnosing and treating child sexual abuse have changed since the practices criticised by the Medical Council in the case of Dr Moira Woods, writes Carol Coulter.
It is now largely forgotten that when Dr Moira Woods began seeing child victims of sex abuse in the Rotunda Hospital in 1985, many people did not believe such things even happened.
Kieran McGrath, editor of the Irish Social Worker and a specialist in the area of child sex abuse since 1988, recalls the first such case he encountered as a young social worker.
"I didn't know what to do. I asked a manager, who asked me the age of the child, and I said about eight. He said not to worry, as such things only happened to precocious teenagers, and that all the research indicated this. Of course, we now know this was completely wrong."
He pointed to a widely-used English textbook on the law of evidence which, in its 1984 edition, warned against the evidence of children. Among the reasons for treating it with suspicion were: "Children sometimes behave in a way evil beyond their years . . . they may consent to sexual offences against themselves and then deny consent. They may completely invent sexual offences . . ."
Therefore, the emphasis of those working in the area was to stress that when children tried to tell people about being sexually abused, they were usually telling the truth.
"The thrust of the protocols and the textbooks at that time was to overcome the legacy of suspicion, that 'children tell lies about these things', and stress instead, 'listen to the child'," said McGrath. This was the context in which Dr Woods's unit was operating.
Very soon after it was set up, the Department of Health and the maternity hospitals recognised that a specialist unit or units would have to be set up for children. But this took three more years.
In the meantime, the whole area had exploded internationally and provoked widespread public debate.
One of the most significant incidents was the Cleveland crisis, where a number of families claimed they had been falsely accused of sexually abusing their children. An inquiry was launched, which reported in 1988, just as the specialist child treatment units were being set up in Temple Street and Crumlin children's hospitals.
The Cleveland report found that mistakes in diagnoses had been made, and doubt was cast on one specific physical diagnostic technique used by the paediatrician involved, Dr Marietta Higgs.
However, the inquiry also confirmed the existence of widespread child sex abuse and vindicated Dr Higgs's conclusions in most cases.
It recommended a number of safeguards in the investigation and validation of child sex abuse, especially the avoidance of the reliance on a single diagnostic tool, the involvement of multi-disciplinary teams and guidelines for interviewing children and their parents.
These recommendations were available to the units in Temple Street and Crumlin.
"There is great complexity in such cases, there can be many twists and turns in an investigation," said McGrath. "At the end of the day, you can be none the wiser.
"One of the biggest changes nowadays is in relation to fathers. It is standard practice now to ensure that both parents are interviewed, even if they are separated and if the father has not been very involved in the child's life. They are usually interviewed before the child is. People are kept up to date with the investigation. They are not just presented with a conclusion."
If parents are dissatisfied with a conclusion, they can seek a second opinion, and a specialist from Northern Ireland is frequently called in for this. "You are more likely to be asked for it by people who think there was abuse and you didn't discover it," said McGrath.
Children First is the title of the national guidelines introduced in 1999 to improve the identification, referral and treatment of children at risk, and to promote a multi-disciplinary and multi-agency response. It is aimed mainly at practitioners in child protection and the Garda Siochána, while also seeking to educate the public.
Linda Gallagher is a team leader on secondment from the North-Western Health Board working with Children First. She told The Irish Times that the guidelines offer a framework for the standardisation of methods of identifying abuse (including physical and emotional abuse and neglect), drawing up standard report forms so that if other professionals report suspected abuse it can be processed in the same way throughout the State, and balancing the child's voice with the empowerment of parents.
A child protection notification system is being developed, she said, where a multi-disciplinary team will review the case of each child notified, and a child protection and monitoring system put in place, following assessment. Like McGrath, she said that neglect often did more lasting damage to a child than sexual abuse.
Early intervention and prevention are crucial, she said.
However, it is already known that there is a severe shortage of social workers in this area, especially experienced and skilled people.
While those working in the area say that very careful work is now being done, there are not enough experienced people to provide a comprehensive service.
Guidelines and practice in identifying and dealing with child abuse, including sexual abuse, are certainly much more developed and refined now than they were in 1985.
But they need highly-qualified and trained people to implement them in this, one of the most emotive and stress-filled areas of our social services.
That is the gap that should now be filled.