Background

Childhood sexual abuse (CSA) is increasingly recognised and the impact often lifelong.1 At least 15% of girls/young women and 5% of boys/young men experience some form of sexual abuse before the age of 16 years,2 after which they may be offered sexual health follow-up (SHFU) from a paediatric sexual abuse referral centre (SARC). For children and young people (CYP) and their carers, the visit may be anxiety-provoking or risk revisiting trauma. For referring teams, there may be barriers to finding an appropriate provider, especially for CYP aged under 13 years who cannot attend standard sexual health clinics. For primary care providers, these consultations may feel beyond day-to-day competencies.

Why was the project needed?

The Bridge paediatric SARC, based in Bristol, provided by University Hospitals Bristol and Weston NHS Foundation Trust, coordinates SHFU across three counties (Avon and Somerset, Gloucestershire and Wiltshire) and refers on to general practitioners (GPs), and paediatric and sexual health clinics. A baseline audit showed that one-fifth of the 200 CYP using the service each year did not attend SHFU, with informal feedback highlighting difficult interactions including:

“She’s quite young, she doesn’t really understand what happened, she doesn’t really know The Bridge, she doesn’t know what an STI test is…”

“She felt incredibly uncomfortable … in a normal local sexual health clinic…”

We found a service gap for survivors needing high-quality, evidence-based sexual health and HIV care. We carried out an ambitious, trauma-informed, co-production pathway redesign in which young survivors were placed at the centre, guided by psychological expertise …