The Oxford Child Sexual Abuse Examination Skills Trainer (OxCAT)

December 18, 2014

 

At the launch of OxCat in 2011 Earl Howe, then Opposition Spokesman for Health and Social Services in the House of Lords, when opening his address began by reminding Forum delegates that “child protection…. is an emotive subject in the mind of the general public” and that child sexual abuse “is seen by many as repellent in a way that nothing else is…”.

Today, we only have to look at the news to be reminded that the need for such a training aid is no less important than it was when first launched

The Oxford Child Sexual Abuse Examination Skills Trainer (OxCAT)

Developed by Dr Sue King, an associate specialist in community paediatrics at the Oxford Children’s Hospital and Dr Sheila Paul, a Buckinghamshire GP and forensic physician for Thames Valley Police, working with NHS Innovations South  East (NISE).

Summary

The OxCAT Trainer consists of an anatomical model and a DVD and is used to train medical practitioners and other authorised specialists in carrying out a colposcopy in suspected cases of Child Sexual Abuse (CSA).

Diagnosing CSA is extraordinarily difficult and the stakes are obviously extremely high for everyone concerned.  Crucially, accurate diagnosis requires a proper understanding of the wide variations that may be found in the appearance of the hymen and other genital tissues in prepubertal girls.   The main reason why the OxCAT is so badly-needed is that there are variations in hymenal appearance - including congenital presentations - which can be mistakenly identified as symptoms of abuse. 

Evidence of implementation

Organisations where the OxCAT has been implemented 

  • University Hospital of North Staffordshire
  • Essex Medical & Forensics Services
  • Lancashire Teaching Hospital
  • North Wales NHS Trust
  • Doncaster Royal Infirmary
  • Bletchley Police Station

Effect on quality of care 

Safety  

  • Improved assessment of child abuse cases facilitates earlier evidence-based intervention benefiting the safety of potential victims.

Effectiveness  

  • Current approaches rely on poor quality photographic illustrations.  Stringent consent requirements have reduced the opportunities for practitioners to train on children.  OxCAT offers the next most effective alternative.

Patient experience  

  • Prevention of mis-assessment even in a single case brings with it immeasurable benefit to all parties

Effect on productivity 

  • The effect of OxCAT on productivity has not been formally measured.  However, OxCAT offers improved training of those involved in the assessment of cases as well as better illustration in legal settings.

Notes:

Some estimates put the prevalence of Child Sexual Abuse among children as high as 11%.   

The Physical Signs of Child Sexual Abuse; an evidence -based review and guidance for best practice. Pub. Royal college of Paediatrics and Child Health,  March 2008 

http://ukpmc.ac.uk/pagerender.cgi?artid=1347996&pageindex=3#page 

http://pediatrics.aappublications.org/cgi/content/abstract/89/3/387

Target groups that would benefit from this training tool include: 

  • Junior doctors (during training)
  • Allied professionals (specialist nursing and social work staff).
  • Specialists in the criminal justice system; police, prosecutors, defence counsel, judiciary
  • Faculties of Forensic & Legal Medicine
  • Sexual Abuse Referral Centres 

(NB The Royal College of Obstetrics and Gynaecology in collaboration with the Royal College of Paediatrician is setting up a specialist Diploma Course in SCA examination.)

 

 

 

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