I read with interest the article by Mok, Busuttil and Hammond (1998) and the commentary by Wynne (1998) on Joint Forensic Examinations. As stated by Dr Wynne several models regarding the medical examination of sexually abused children have evolved in the UK, very often depending on the interests of the local Community Paediatricians and the concerns of Police and Social Services.
Here in North East Wales in the Clwydian Trust, covering the counties of Denbighshire, Conwy (part), Flintshire and Wrexham, the Community Paediatricians have had a long interest and active involvement in all areas of child protection. Since 1989 the North Wales Police have actively promoted the forensic training of Community Paediatricians, with excellent courses, covering not only forensic skills, but also report/statement writing and giving evidence in court.
The police provide dedicated houses through North Wales, equipped for joint video interviewing and the medical examination. Referral is via Police and/or Social Services. As described in Mok et al. (1998), this is a child-centred examination but the paediatric and forensic examinations are both done by the community Paediatrician. There are excellent links with the hospital based STD service where `quiet' appointments are oered.
The Community Paediatrician is able to attend the Child Protection case conference and agree any medical monitoring and can remain actively involved in follow-up. All sexual abuse examination of children and a high percentage of adult examinations, associated with the cases, are performed by Community Paediatricians and have been since 1989.
Concern has been expressed by Mok et al. (1998) that not all victims are oered a medical examination. We have recently drawn up `Good Practice Guidelines for Medical Examination and Follow-up of the Child/Young Person who has been Sexually Abused or who presents with Risk Taking Behaviour'. These guidelines will be discussed with Social Services and Police colleagues, to highlight this issue and the morbidity relating to undiagnosed and untreated STD, if health assessment is not oered.