1. Establish whether the children is already sexually active and in what circumstances is the sexual activity occurring and with whom.
- a child cannot consent to sex with an adult of 18 years and older
- a child aged 12 and under cannot consent to sexual activity
- a child cannot consent to sex with an adult in a position of authority
2. The doctor should attempt to exclude rape through exploitation. These four questions have 89% sensitivity and 100% specificity for identifying young people at high risk of child sexual exploitation (CSE)
- Have you ever stayed out overnight or longer without permission from your parent(s) or guardian?
- How old is your partner or the person(s) you have sex with? (Is the age difference 4 or more years?)
- Does your partner stop you from doing things you want to do?
- Thinking about where you go to hang out, or to have sex. Do you feel unsafe there or are your parent(s) or guardian worried about your safety?
3. If there is potential that a sexual crime is being committed against a child a referral to the police is a professional obligation.
- When there is significant risk of sexual exploitation it is likely that the doctor will need to break patient confidentiality and disclose information without informing the child/patient.
- The doctor must take steps to ensure the police have been contacted about this potential crime and should notify the police even if the patient/witness says they have already been informed.
4. "Fraser Guidance" then dictates that a doctor can prescribe contraception if:
- The girl (although under the age of 16 years of age) will understand his advice.
- They cannot persuade her to inform her parents or to allow him to inform the parents that she is seeking contraceptive advice.
- She is very likely to continue having sexual intercourse with or without contraceptive treatment.
- She receives contraceptive advice or treatment her physical or mental health or both are likely to suffer.
- Her best interests require him to give her contraceptive advice, treatment or both without the parental consent.
Reference:
- Coventry and Rugby CCG. Child Safeguarding (Accessed 7/6/2016)