Children failed

IT is shocking to think the state provides no dedicated specialist services to examine, interview and support young children who have been sexually abused or assaulted.

It is even more alarming that two doctors dedicated to developing a service in the West of Ireland have withdrawn their expertise due to a continued lack of funding and support from the HSE.

We all know times are tough, but what about the promises made since the Ryan Report, the Murphy Report, the Roscommon Inquiry, and countless others back to 1999 when Children First guidelines were published.

The continued failure of the state to fulfil those promises remains a damning indictment of where the Government’s priorities lie.

Dr Joanne Nelson, a paediatrician and forensic examiner who has been trying to develop a sexual assault treatment unit for young people in the West, said that while there is “talk” about the issue, there is still no direction, no vision and, of course, no money.

After the horrors of the Roscommon case, this is inexcusable.

Child sex abuse, however much we want to believe to the contrary, is not uncommon and children must be examined and treated like other victims of sexual assault.

More than two years ago, Dr Nelson, who worked in child protection in Belfast for nine years and was involved in the development of services there, presented the HSE with a top-quality blueprint on how to go about setting up a gold star service.

The proposal was for a consultant-led paediatric sexual assault treatment unit to be located in Galway and to facilitate joint investigations, essential to protect young people from the trauma of multiple interviews.

It was modelled on that of a Sexual Assault Referral Centre (SARC) and would involve health, social services and gardaí. It would be a multi-agency team approach, a “one-stop shop” on a single site.

Dr Nelson and a colleague, Dr Roger Derham, a gynaecologist and forensic examiner, managed to get the HSE to fund special equipment to examine young children and began providing an out-of-hours service, employed by the HSE on a case-by-case basis.

Far from satisfactory, the arrangement, provided for in a room in a private hospital, relies on the goodwill of the private hospital which will cease at the end of this year.

On November 30, the HSE wrote to Dr Derham informing him that the equipment could be moved to the adult sexual assault treatment unit (SATU). According to the letter, “this means the service for children which you have kindly provided to date can continue on the current basis”.

It went on to say the service would continue to be an ad hoc, fee-paying, normal working day service.

In his response to the HSE, Dr Derham said he “fully understand the financial constraints that the HSE West is faced with in trying to match services to a diminishing funding base, but unfortunately that is not an opt out”.

“The provision of adolescent and child SATU services is a national, not regional, issue,” he wrote.

“This is a desultory and offensive proposal. I have endeavoured to provide a service (without any on call fees) for the past six to seven years in the hope that the work and planning, that I, but most particularly Dr Nelson, have undertaken to establish an appropriately funded and staffed and managed paediatric and adolescent SATU in the best interests of those children. I am not prepared to offer my services in support of such a deficient proposal and therefore withdraw the voluntary facility and expertise I have provided to date from the 19 December 2010.”

So, two experts in their field providing a top quality service have now been forced out because of the lack of commitment from decision-makers on high.

Are these are the same decision-makers who pledged reform in relation to child protection in the wake of the most scandalous and heinous report ever to be published on institutional sex abuse?

Does the same Minister for Children, who in October spoke of his “feelings of shock and anger” in relation to the Roscommon inquiry, know that this is happening?

People need to know the answers to these questions.

Indeed, as the Roscommon report quite astonishingly pointed out, there is still no regional specialist child sexual abuse team or unit available in the west of Ireland to build up experience and expertise in child sexual abuse assessment.

That alone tells you our government and decision-makers are not serious about this issue.

While some will argue there are other causes which need prioritising in these economic times, if we don’t do this now, then when?

When will it be a good time to treat abused children with the dignity they deserve?

One look at the Sexual Abuse and Violence in Ireland Report (SAVI), tells us how high the prevalence of child sex abuse in this country is.

Profiling indicates that three quarters of cases are female with an average age of nine years.

Extrapolating figures from it tell us that about 600 children in Ireland under the age of 15 years may need paediatric medical forensic evaluation annually — with 60 of these being emergency cases.

How can it be justifiable not to provide such an important service for 600 young people every year?

While Dr Nelson’s initial proposal to the HSE had aimed for a gold standard service, a scaled-down version simply including 24hr access to adequate medical care for child sexual assault is not even achievable.

How many more reports do we have to read before we take child abuse seriously? And, furthermore, how long before we put services in place to adequately examine and interview children —and help prosecute their abusers.

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