Week 2 (Day 4) - Young person's capacity, Fraser/Gillick, When to inform Child protection

Question 1

What is the legal age of consent for sex?

Answer 1

Legal age of consent is 16 years old

Question 2

• Who is breaking the law and what are implications if: – Two 14 year olds have sex?

Answer 2

Technically both a re breaking the law as they are both under the age of 16 but if capacity is present in both then procurator fiscal wouldn’t deem it worthy to try this case

Question 3

– A 14 and 16 year old have sex? who is breaking the law

Answer 3

Technically the 14 year old is having sex below the legal age of consent But the 16 year old is sleeping with a minor and and this is technically statuatory rape - usually charges arent pressed unless the minor did not give consent to the act

Question 4

If a person is known to have sex with a child below the age of 13, what happens and why?

Answer 4

CHildren below the age of 13 are deemed to not have capacity to consent to sexual activity and therefore the person who had sex with child is likely to be prosecuted under statuatory rape - rape of young child as below the age of 13

Question 5

What happens if A 12 and 16 year old have sex?

Answer 5

If a child under 13 years discloses penetrative sex or other sexual activity the practitioner must always discuss with their designated safeguarding lead. A referral to police and children’s social care must be made where a child under 13 is believed to be engaged in penetrative sexual activity, or in any other intimate sexual activity. .

http://westmidlands.procedures.org.uk/pkplh/regional-safeguarding-guidance/sexually-active-children-and-young-people-including-under-age-sexual-activity

Question 6

Ethical considerations if becoming aware of someone having sex under 16? If under 16 – does the child have capacity? What guidleines must the child meet? (between the ages of 13-16)

Answer 6

Child must be Gillick competent if under 16 to have sex ((Gillock competence applies to all capacity under 16 but Fraser Guidelines is specific to contraception and sexual advice/treatment))

Question 7

What are the 5 fraser guidlines? These guidelines are required when a child requests contraception and is below the age of 16

Answer 7

• 1. He/she understands the advice given re:treatmet
• 2. He/she cannot be persuaded to tell her parents or to allow the doctor to tell them
• 3. He/she is likely to continue having sexual intercourse with or without contraception
• 4. His/her physical or mental health is likely to suffer unless he/she received the advice or treatment
• 5. The advice or treatment is in the young person’s best interests.

Question 8

• 1. Do you have any child protection concerns?
• 2. What action would you take regarding the underage sex?
• 3. What options can she be offered for emergency contraception

Answer 8

• 1. No child protection concerns
• 2. Educate child about underage sex and sexual guidance - also document that the child has met Fraser-guidlines and is gillick competent
• 3. Can give Levonelle (LNG -EC - up to 72 hours) EllaOne (UPA-EC - up to 120 hours) or Copper IUD (up to 120 hours or 5 days after earliest estimate of ovulation)

Question 9

4. When can she start regular contraception?

Answer 9

• If LNG-EC
  
  • * Can start contraception straight away and use barrier method for 7 day also
• If UPA-EC
  
  • * use barrier method for 12 days, start contraception after 5 days
• If IUD -
  
  • * this is emergency contraception and can stay in as contraception for 5-10 years

Question 10

1. Do you have any child protection concerns? 2. What action would you take regarding the underage sex? 3. Are there tests that can be done that may help in a court case? (how long post UPSI can forensic testing be carried out) 4. What sexual health screening is indicated?

Answer 10

• 1. Yes there are child protection concerns - being intoxicated comes under not able to provide consent and could be classified as rape
• 2. Yes would advise her to share with child protection services but if not then you have to as he could do this to other girls
• 3. Forensic testing can be carried out up until 7 days post intercourse
• 4. Screen for STIs (CT, GC, HepB, HIV, syphilis)

Question 11

1. What is the provisional diagnosis? 2. What further tests should he have to complete his sexual health screening? 3. What treatment would you give him for this diagnosis?(what would you give if he cannot take IM treatment)

Answer 11

1. Gonococcal infection (neisseria gonorrhoea)
2. First pass urine to screen for chlamyida, also test for Hep B, HIV, Syphilis Also carry out a pharyngeal and rectal swab
3. Would give IM ceftriazone and oral azithromycin If he cant take IM treatment, oral cefixime and oral azithromycin

Question 12

What partner notification is advised in this case?

Answer 12

• Urethral infection - look back period would be two weeks for previous partner
• If pharyngeal or rectal swabs come back positive, would looks back for partners in previous 3 months
• basically notify the partner from 2 weeks and 2 months ago

Question 13

What percentage of people are asympotmatic for chlamydia and gonorrhea infections?

Answer 13

Chlamydia Male - 50% Female - 70%

Gonorrhea Male - 10% Female - 50%

Question 14

There are many factors to consider in a young person’s capacity when consenting to sexual activites Important in the history to understand, the age of people whom were involved, gender based violence, position of power, grooming What is an example of grooming?

Answer 14

Where a person indulges or coerces a young person by buying gifts or presents in order to have a close relationship with the child