Working with child sexual abuse survivors to improve their experiences of sexual health services

A health psychologist at UWE Bristol has worked with partners to develop improved services for children and young people who have experienced sexual abuse.

Through Bristol Health Partners Sexual Health Improvement Health Integration Team (SHIP) HIT, Associate Professor in Health Psychology Dr Jane Meyrick collaborated with health professionals, service providers and local authorities to work with survivors of child sexual abuse to improve their experiences of sexual health services in the city.

The partners hope the improvements will help increase attendance at sexual health follow-up appointments after visiting The Bridge Sexual Abuse Referral Centre (SARC) in Bristol. Children and young people who have experienced sexual abuse are referred to the centre for sexual health services and testing but an audit of The Bridge’s paediatric service showed one in five children and young people were not attending their follow-up appointment.

The partnership work resulted in a new patient pathway for The Bridge SARC in Bristol into local sexual health services for our children and young people, designed with the young people who use it. The redesigned and co-created pathway has been in use since January 2023 and its effectiveness will be evaluated at the end of the first year.

Child sexual abuse often has a lifelong impact. At least 15 per cent of girls and young women and five per cent of boys and young men experience some form of sexual abuse before the age of 16. After this happens, they may be offered support from a paediatric Sexual Abuse Referral Centre (SARC) and a sexual health follow-up referral.

The Bridge SARC, provided by University Hospitals Bristol and Weston NHS Foundation Trust, coordinates sexual health follow-up for children across Avon and Somerset, Gloucestershire, and Wiltshire. Around 200 children and young people are referred each year through GPs, and paediatric and sexual health clinics.

For children and young people, and their carers, attending a SARC may provoke anxiety or risk revisiting their trauma. Informal feedback highlighted that some interactions had been difficult.

The review showed that some health care professionals working in primary care (e.g. GP practices) felt that they did not have the right skills to carry out consultations well with children and young people who have survived sexual assault.

To identify ways to improve the service, SHIP HIT members approached The Green House, a special support service for child sexual abuse survivors in Bristol. They asked if the young people involved would let them work with them to think about changes that could be made to the pathway that would increase sexual health follow-up attendance.

Dr Jane Meyrick, The Bridge’s Rachel Adams, and The Bridge’s crisis worker Hope Barraclough worked with young people from the Green House in the post-therapy stage of recovery, alongside their trusted ‘voice’ worker, with ongoing support from a crisis worker and an established safeguarding framework. They used creative, arts-based workshops to develop characters needing to use the service, ensuring a safe distance from the participants’ own trauma.

The ideas that the young people developed were made into a patient ‘passport’ to help children, young people and their carers navigate and tailor the sexual health follow-up service.

Dr Meyrick, who is SHIP HIT’s patient and public involvement lead, said:

“We realised that we needed to ask young people what they wanted, and we needed to do it in a way that truly put them in the driving seat of redesigning the pathway. So, wherever possible, we found ways that we could give the agency back to these young people, in terms of where they came for testing, what they brought, who they saw, or what information they had.

“This resulted in a patient pathway that was like a passport – we called it a map of the journey. It’s a way through the service, explaining the options at each stage and trying to make that very accessible, warm, and friendly, but also informative. At the same time, we addressed the information needs of some of the parents and clinicians, so there is a parallel professional pathway next to the passport.”

Hope Barraclough, a crisis worker at The Bridge SARC, said:

“If another Sexual Assault Referral Clinic wanted to develop a similar pathway, we would strongly encourage they run a project like ours in their own area to ensure the children and young people’s voices continue to be at the centre of service design.”

Read the paper

‘Co-produced patient pathway for sexual health follow-up with children and young people using a paediatric sexual assault referral centre (SARC): facilitating elements of self-care and self-testing’ Jane Meyrick, Rachel Adams, Michelle Cutland, in BMJ Sexual & Reproductive Health