Referrals & response to children in need of protection

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Referrals & response to children in need of protection

Referrals

Responding to children in need of protection

Referals

INTRODUCTION

All individuals working with children have a duty and responsibility to report any child protection allegations and concerns, which come to their attention

This section sets out the processes in making a referral if there are concerns and the initial actions of Children and Family Services.

UNCLEAR SITUATIONS

If it is unclear whether a child is suffering or likely to suffer significant harm, discussions should be held with your agency child protection advisor and/or with the Children and Family Services Referral and Assessment Team Manager. If a Manager is unavailable, contact should be made with the Duty Social Worker

Seeking advice is an essential part of working together and should be encouraged at all times.

TALKING TO PARENTS/CARERS

In the majority of cases, it is good practice to be open and honest at the outset with the parents/carers about concerns, the need for a referral, information sharing between agencies and the accompanying need for making an enquiry in respect of whether a child is subject to a child protection plan.

All reasonable efforts should be made to inform parents/carers prior to making the referral. However, a referral should not be delayed if you are unable to discuss the concern with the parents.

Where a child expresses a wish for his or her parents not to be informed, their views should be taken seriously and a judgement made, based on the child’s age and understanding, as to whether the child’s wishes should be overridden.

There are cases where you should not discuss concerns with parents/carers before making a referral. Concerns must not be discussed with parents/carers before referral in the following circumstances:

Where discussion would put a child at risk of significant harm
Where discussion would impede a Police investigation or social work enquiry
Where sexual abuse is suspected
Where organised or multiple abuse is suspected
Where the fabrication of an illness is suspected
Where to contact parents/carers would place you or others at risk
Where it is not possible to contact parents/carers without causing undue delay in making the referral.

In such cases, advice should be sought from Children and Family Services and/or the police.

REPORTING CONCERNS

If there are concerns that the child is suffering or is likely to suffer significant harm a referral should be made immediately.

A written confirmation of the referral must be completed and submitted within 48 hours.

Professional staff should contact Children and Family Services through the Customer Advice Centre or the Emergency Duty Team. The referrer should:

Clearly identify themselves, their agency and give details of where they can be contacted that day.
Provide as much family information as possible, clearly stating the name of the child, the parents/carers and any other children known to be in the household, the dates of birth and addresses and any previous addresses known
Provide details of any special needs or communication needs of either the child or any family member
State why they feel the child is suffering, or is likely to suffer, significant harm.
Share their knowledge and involvement of the child(ren) and family
Share their knowledge of any other agency involved
Indicate the child’s, parent’s/carer’s knowledge of the referral and their expectations
Ensure they record within their agency files the concerns and action taken
Confirm the referral in writing using the CYCSB Child in Need of Protection Referral Confirmation Form.

The referrer is entitled to:

Receive an explanation from the Children and Family Services of what will happen next
Be provided with the name of a contact person within Children and Family Services in respect of who will be dealing with the referral
Receive information on the outcome of the referral within seven working days.

CHECKING IF A CHILD IS SUBJECT TO A CHILD PROTECTION PLAN (FORMALLY KNOWN AS THE CHILD PROTECTION REGISTER)

Any authorized user can make an enquiry to check whether a Child is subject to a child protection plan or the YorOK Child Index team on 01904 554268 in order to establish whether the child or family is known. Enquiries can be either made in person, by telephone or in writing.

The Designated Manager (children subject to a child protection plan) will provide basic information (e.g. if the child is known to the Register) and will direct the inquirer to the relevant Children and Family Services Children’s Services Team or individual worker involved.

If the child is currently the subject of a child protection plan, the Designated Manager (children subject to a child protection plan) will follow up the enquiry by contacting the key worker or relevant Service Manager to ensure they are aware of the enquiry.

Out of office hour’s enquiries can be made by telephone to the Emergency Duty Team (01904 762314 – 24 hour availability), which holds an index listing basic details of all children who are subject to a child protection plan.

ASSESSMENT OF NEED

On receipt of a referral stating that a child may be suffering from, or is at risk of future significant harm, the relevant Children and Family Services team (usually the Referral and Assessment Team) will need to take the following steps:

Clarify with the referrer (including family or concerned members of the public) the nature of the concerns, i.e. do the concerns amount to abuse or neglect; how and why they have arisen; and the apparent needs of the child and family
Speak to the child concerned within 24 hours of the allegation being made. If this timescale is not met, the reason for the failure must be recorded in the case file
Make a judgement about the immediate safety of the child or children.
Make a decision about the next course of action within 24 hours. This decision would be taken following a discussion with the referring agency, examining existing records, and involving other professionals and agencies (including the police) This decision is taken by the Service Manager of that team, or if not available, the Duty Manager.

The outcomes at this stage can be:

No Further Action – In which case, the referrer will be informed of the reason and the family informed that an enquiry has taken place. This should be done in writing although in exceptional circumstances this may not be appropriate. If this is the case, reason for not informing the family should be clearly recorded.
Initial Assessment – Initiate an initial assessment under Section 17 of the Children Act 1989 if the judgement is that there are no child protection issues, but that the family may be in need of services.
Child Protection Procedures – Initiate Child Protection Procedures.

Whatever the decision taken, it should be agreed by the Service Manager and recorded in writing, with the reason. The referrer, if a childcare professional, should be informed of the decision.

APPLYING CHILD PROTECTION PROCEDURES

Child Protection Procedures are triggered where there is reasonable cause to suspect that a child/young person, under the age of 18 years, is suffering, or is likely to suffer, significant harm.

Child protection procedures apply to any child living or staying within the City of York Area.

Child protection procedures apply where the suspected or alleged abuser is a member of the immediate or extended family, a friend or acquaintance or carer, a person known to the child or family, a professional working with the child or family or a foster carer.

Where a suspected or alleged abuser not known to the child or family, it may not be necessary to apply child protection procedures. However, the decision should be based on whether adequate parental care was a factor. However, in such situations, the Police should always be involved.

DISAGREEMENTS

If the professional making the referral disagrees with the Children and Family Services decision about whether child protection procedures should be applied, they should discuss this with the Child Protection advisor in their agency, who may wish in the first instance to contact relevant Service Manager.

Where a disagreement cannot be resolved reference should be made to the CYSCB procedure ‘Resolution of professional concerns and disputes’.

DECISION TO APPLY CHILD PROTECTION PROCEDURES

The decision to apply child protection procedures should be recorded in the case notes, which should include, the date, and time of the decision and the responsible Manager.

EMERGENCY DUTY TEAM RESPONSIBILITIES

If concerns relating to significant harm are raised out of office hours, the Emergency Duty Team worker (EDT) taking the referral will consult with the EDT Manager or EDT Team Leader and will make enquiries of:

Any available agency
Any available records or agency checking systems
If necessary, refer back to the source of the information to obtain further detail.

The EDT worker will consult with the EDT Manager/Team Leader on completion of the above enquiries, to agree a plan which includes the following actions:

Undertake any urgent investigation if necessary
Identify and action any immediate steps necessary to protect children

The EDT Manager/Team Leader will:

Authorize Section 47 enquiries, if necessary
Ensure the Police are consulted and that joint action, if appropriate is arranged
Authorize any immediate action necessary to protect children
Ensure that any decision taken to handover the enquiries to Children and Family Services is communicated to the other agencies involved.

The EDT Manager/Team Leader will ensure the appropriate paperwork is forwarded to the relevant Children Services Team in order that they are able to continue with the enquiries. A copy will be sent to the Customer Advice Centre.

The EDT worker will:

Inform the relevant Service Unit of information received and action taken at the start of the next working day.
Be available to attend an initial Child Protection Conference where their involvement was significant, or to provide a written report if unable to attend.

Responding to child in need of protection

INTRODUCTION

This section sets out the procedures carried out when a decision has been made to respond to a situation to using Child Protection Procedures.

IMMEDIATE PROTECTION

At all times consideration must be given to the protection of the child from further harm.

Where there is a risk to the life of a child, or a likelihood of serious immediate harm, the Police and Children and Family Services will act immediately to secure the safety of the child. Importantly, in cases of imminent risk the police should be contacted via 999.

In extreme cases, professional staff from other agencies may need to use their judgement to take protective action, e.g. to seek urgent medical treatment or to refuse to return a child to a parent until the Police or Children and Family Services arrive. Consideration should also be given to safeguarding any other children in the household.

Planned emergency action, including medical assessment, will normally take place following a Strategy Discussion between the Police, Children and Family Services and other agencies as appropriate. If this is not possible, the Strategy Discussion must take place as soon as possible.

If the child is looked after by, or subject to a child protection plan in another local authority area, and where the ‘home’ authority explicitly agrees to accept responsibility for taking emergency action, the City of York may agree to transfer the operational responsibility. However, agreements must be confirmed in writing.

STRATEGY DISCUSSIONS

Wherever there is reasonable cause to suspect that a child is suffering or is likely to suffer significant harm, there must be a Strategy Discussion. The Children and Family Services Service Manager should convene the Strategy Discussion within 24 hours of the referral being made. The precise timing of the meeting will be dependant on the degree of perceived risk to the child.

The Children and Family Services Service Manager and a member of the Police Child Abuse Investigation Team (CAIT) will attend the Strategy Discussion. If a meeting is held, the referrer, if a childcare professional, should be invited.

A Consultant Paediatrician should be invited in serious cases and all child sexual abuse cases. In all cases where there is likely to be the need for medical examination a Consultant Paediatrician should be consulted, and arrangements for the medical examination agreed.

Attendance of other involved childcare professionals especially Health and Education should always be considered. A list of those invited and attending should be recorded in the record of the meeting.

A Strategy Discussion is not a substitute for a Child Protection Conference. Its purpose is to consider the following issues:

Share information and establish the facts about the circumstances giving rise to the concerns
Decide whether Section 47 enquiries should be initiated or continued
Plan how enquiries should be handled, and by whom
Decide if there is a need for medical assessment or treatment
Decide whether an investigative interview should be carried out
Identify sources of risk and assess the levels of risk
Decide what action is needed immediately to safeguard the child and any other children and/or provide interim services and support
Determine what information about the Strategy Discussion will be shared with the family, unless such information sharing may place a child at risk of significant harm or jeopardise police investigations into any alleged offence.

Relevant matters will include:

Agreeing who should be interviewed, by whom, when and for what purpose
Deciding the timing and handling of interviews with alleged victims, their families and witnesses (the way in which interviews are conducted can play a significant part in minimising any distress caused to children, thus increasing the likelihood of maintaining constructive working relations with families)
Considering if a criminal offence may have been committed against a child (this can have important implications for the collection and preservation of evidence)
Considering how the race, ethnicity, religion and culture of the child and family should be taken into account and whether an interpreter is needed
Considering how any disability of the child and any member of the family should be taken into account and how the process of making enquiries can be adapted to ensure their full participation
Considering the needs of other children who may be affected (e.g. siblings and other children in contact with alleged abusers)
Consideration should be given on the impact of the gender, race and religion of professionals involved in making the enquiries
Agreeing a plan for enquiries – what further information is needed about the child and family and how it should be obtained, and agreeing the timescales
Consider nominally booking a time for an Initial Child Protection Conference with the relevant Administration Coordinator – Independent Reviewing Officer Team.

Any information shared, all decisions reached, and the basis for those decisions should be clearly recorded by all parties to the discussion.

Significant harm to children gives rise to child welfare concerns and legal considerations, and Section 47 enquiries may run concurrently with the Police investigations concerning possible associated crime(s). The Police have a duty to carry out investigations into allegations of crime, and the obtaining of clear strong evidence is in the best interests of a child.

IMMEDIATE PROTECTION FOLLOWING THE STRATEGY DISCUSSION

If the Strategy Discussion agrees that a child is at risk of significant harm, consideration should be given to the most effective way to protect the child.

Where it is assessed that the child is at risk of significant harm, agreement should be sought from the parent/carer, in the first instance, as to the more effective means of safeguarding the child. Where possible children should remain within the family or extended family. When deciding the most effective means of protecting a child the following options should be considered:

A parent taking action to remove an alleged perpetrator
The alleged perpetrator agreeing to leave the home
A parent agreeing that a child can move to relative or family friend
The parent agreeing to voluntarily foster care

Where a voluntary agreement is reached, parents/carers should be informed that the local authority reserves the right to apply for a court order, to protect the child, if agreements are breached or where arrangements fail.

Voluntary arrangements with parents, should always consider the non-accused parent’s preparedness to accept the possible risk along with their willingness to cooperate. All such arrangements should be written into a ‘parental agreement’ with all conditions, contained within the agreement, being verifiable. Parental agreements must always include contingency arrangements dealing with non-compliance. Agreements must always be dated and signed by each parent/carer, others referred to in the agreement, the social worker, and the Service Manager.

In the event of non-compliance or suspected non-compliance, and where it is decided not to trigger the stated contingency arrangement, the reason must be recorded and countersigned by the relevant Group Manager.

Children and Family Services must seek legal advice, with a view to instigating care proceedings, if voluntary action cannot be taken to protect the child or where there is evidence of non-compliance with the requirements made by Children and Family Services or the police. If it is necessary to remove a child, Children and Family Services will normally apply for an Emergency Protection Order, unless a child’s safety is at immediate risk; in such cases the Police should exercise their powers to protect the child.

JOINT INVESTIGATIONS AND SINGLE AGENCY ENQUIRIES/INVESTIGATIONS

Judgement needs to be exercised in respect of whether enquiries should be undertaken jointly or by single agency investigations. A single agency investigation should become a joint investigation if the criteria are met.

As some cases will not be clear at the outset, consultation and negotiation must take place between Police and Children and Family Services and a strategy agreed.

CRITERIA FOR JOINT INVESTIGATION

A joint investigation between Children and Family Services and the Police should be undertaken:

If the allegation is of sexual abuse
If it appears that criminal charges might result from the investigation because it involves allegations of serious physical harm or serious neglect
If, in cases of minor physical abuse, the circumstances surrounding the incident indicate that a joint investigation may be appropriate.

Such factors that may assist in determining whether the threshold for a joint investigation have been met include:

Age, special needs, vulnerability and wishes of the child
Any history of minor injuries to the child or family member
The assessed intent of the alleged perpetrator of the assault (e.g. attempted strangulation which may leave no marks but may be very serious) or if a weapon or implement was used
Background of parents/adults giving concern
Other offences that involve unusual circumstances such as organised or institutionalised abuse, bizarre behaviour or Fabricated or Induced Illness.

SINGLE AGENCY ENQUIRIES/INVESTIGATION

The following cases will normally be progressed under a single agency’s procedure; although referral to the Police should be made in every case for the exchange of relevant information and involvement in Strategy Discussions should occur.

Children and Family Services:

Physical abuse or neglect where criminal proceedings are unlikely
Neglect of a minor nature (e.g. through inappropriate supervision or poor parenting skills)
Sexual abuse arising from indirect suspicions or over sexualised behaviour or concerns raised by other professionals.
When a person who poses a risk to children (Schedule 1 Offender) moves into the area and has contact with children.

Police:

Persons aged 17 or over making an allegation of abuse which occurred in childhood.
Where abuse is alleged to have been perpetrated by a person not known to the child or the child’s family (i.e. stranger abuse) providing there are no current child protection concerns arising from the case

RESPONSIBILITY FOR ENQUIRIES

The responsibility for undertaking Section 47 enquiries rests with Children and Family Services.

Where Children and Family Services are not actively involved with the child or its family, the Referral and Assessment Team will undertake enquiries. Where the child is known, the relevant Children and Families Team would usually undertake enquiries.

If the Children and Family’s Disability Team are involved with the child, a member of the team may conduct elements of the enquiry. However, the managerial responsibility rests with the Service Manager of the Referral and Assessment Team unless a change in managerial responsibility is agreed at the Strategy Discussion.

Section 47 enquiries must only be conducted by a qualified Social Worker from the Children’s Services Teams, including Disabled Children’s Teams, the Emergency Duty Team, and/or Police Officers from the Child Abuse Investigation Teams.

In rare circumstances, the National Society for the Protection of Children may exercise their Authorised Status under the Children Act 1989. However, the use of the Authorised Status should be limited to occasions where it is believed that a child is at risk of significant harm and where Children and Family Services has failed in its legal duty under Section 47 .

If the child is looked after by another local authority or is subject to a child protection plan in another authority area, the responsibility to undertake enquiries may be transferred to that authority. In such circumstances, the relevant local authority should be notified immediately of any concern and must agree to accept the responsibility. The relevant local authority must confirm their acceptance of responsibility in writing.

Immediate action to secure the safety of the child in these circumstances may be taken by City of York Children and Family Services. The child’s home Children and Family Services Department may accept responsibility to ensure further enquiries are made and further action, if required, is taken. North Yorkshire Police will be involved if the incident is alleged to have occurred in the City of York.

The relevant Service Manager, will ensure that City of York Children and Family Services is represented at any Strategy Discussion, in order to assess the risk to any other child who is the responsibility of the City of York and to advise on local procedures.

Where the child’s home local authority refuses to take responsibility, City of York Children and Family Services will take responsibility for the enquiry.

If there are concerns regarding a child who is looked after by City of York, or who is subject to a child protection plan in the City of York, Children and Family Services will agree responsibility for any intervention with the relevant local authority. The relevant local authority may be requested to undertake any necessary emergency action, and may take responsibility for the enquiries by agreement with City of York.

ENQUIRIES AND ASSESSMENT

The objective of enquiries conducted under Section 47 is to determine whether action is needed to promote and safeguard the welfare of the child.

The “Framework for the Assessment of Children in Need and their Families” provides a structure for collecting and analysing information obtained in the course of Section 47 enquiries. Consequently, the Core Assessment should be used as the means of recording and analysing information obtained from enquiries.

The purpose of the Core Assessment is to gain insight into the needs of the children and their family’s ability to meet those needs, especially the family’s capacity to ensure the children’s safety, health, and development.

The Children Act 1989 places a statutory duty on Health, Education, and other services to help Children and Family Services with their enquiries. It states:

(9) - Where a local authority is conducting enquiries under this section, it shall be the duty of any person mentioned in subsection (11) to assist them with those enquiries (in particular by providing relevant information and advice) if called upon to do so. Section 10 (9) does not oblige any person to assist a local authority where doing so would be unreasonable.

(11) The persons are:

Any local authority
Any local Education authority
Any local housing authority; and
Any Health authority.

MAKING SECTION 47 ENQUIRIES

CHECKING IF A CHILD IS SUBJECT TO A CHILD PROTECTION PLAN

The Designated Manager (children subject to a child protection plan) holds information on behalf of the Safeguarding Children Board about all children who subject to a child protection plan within the City of York, or for whom there have been child protection concerns.

It is the responsibility of the Children and Family Services Manager involved in the Strategy Discussion to ensure that the Designated Manager (children subject to a child protection plan) is contacted at the beginning of the child protection enquiries, to inform them of the concerns and to receive any relevant information. This may be carried out by a Social Worker.

If the Strategy Discussion occurs out of office hours, the Emergency Duty Team should be contacted as a means of checking whether the child is subject to a child protection plan.

AGENCY CHECKS

The Social Worker must check with all agencies that may have relevant information about the child and their family. This will include a request for information from the Police. The timing of these checks, and who was spoken to, should be recorded on the appropriate documentation.

CONTACT WITH PARENTS/CARERS

The involvement of parents/carers promotes partnership and increases the likelihood of effective outcomes for children.

At an early stage those conducting the child protection enquiries need to identify the resources that will enable them to communicate effectively with parents/carers. Consideration should be given to issues of religion, culture, language, hearing ability, disability, and literacy. The use of independent interpreters with parents/carers may be appropriate and should be considered.

Consideration should be given to the possible complexity of the subject and the use of terminology that is not easily interpreted. Additionally, parents may be unable to speak freely if an inappropriate interpreter is used. Details of how to obtain interpreting services can be obtained from the Police.

Important decisions should be confirmed in writing, or where required other media, in a language that the parent’s/carer’s understands.

Where sexual abuse or child prostitution is suspected, the issue of how parents/carers are involved will need to be decided jointly by Police and Children and Family Services. See relevant procedure for further guidance in situations where children are abused through prostitution.

Where organised or multiple abuse, or fabricated or induced illness, is suspected, the issue of parental involvement will be decided by a strategy meeting.

The purpose of the initial contact with parents/carers is to:

Inform them about the concerns and explain any action already taken
Undertake interviews to ascertain an explanation and/or views regarding the concerns
Gather factual information about the child and family
Request consent to interview the child and any siblings, where necessary
Request consent for the child and any siblings to be medically examined and treated, where necessary
Arrange to see the child
Arrange to see any other children where concerns exist for their welfare.

Parents/carers will also be provided information about advice and advocacy services

LACK OF INVOLVEMENT, CO-OPERATION OR CONSENT DURING ENQUIRIES

There will be circumstances where parents refuse to give consent to the child being seen, interviewed, or medically examined. Additionally, there may also be circumstances where a parent/carer refuses to co-operate in ensuring the child is safe.

In these cases, those conducting the enquiries must consult with their Line Manager to consider further action. Whilst it is important that every effort is made to involve parents/carers, the welfare of the child is the prime consideration. Social Workers must ensure that necessary emergency action to protect the referred child or any other child is taken immediately.

If concerns exist about the parents’/carers’ co-operation with the plan to ensure the safety of the child, and there is a risk of significant harm, or where the parent/carer is suspected to be attempting to subvert enquiries, legal advice must be sought with a view to applying for an Emergency Protection Order. Alternatively, a Police Officer can take immediate action to protect any child by placing them in Police protection.

If it is assessed that there is no need for immediate action to protect the child, those conducting the enquiries must proceed and continue to engage parents/carers. In all cases, parents/carers must be fully informed of the concerns and any action taken or proposed.

Non co-operation is never a reason to close a case; rather, it should be taken as prompting further enquiries.

SEEING AND INTERVIEWING CHILDREN

Those conducting enquiries must see every child within the household, separate to their parents (taking into consideration factors of age and understanding). Observations of the interaction between the child and their parents/carers should be noted. Where the child is living in homeless accommodation or a domestic violence refuge, the observations of hostel/refuge workers should be sought.

The Social Worker should consider the child’s living arrangements and surroundings, specifically, his or her sleeping arrangements and toilet/washing arrangements. Any resistance to this request to should be noted, in particular any tendency to keep the visiting worker to one room.

Communication with the child should be conducted in a manner, which would not allow an adult to influence or contaminate the child’s account. When children are first approached the nature and extent of any harm suffered by them may not be clear. It is important that initial discussions with children are conducted in a way that minimises and maximizes the likelihood of them providing accurate and complete information. Leading or suggestive questioning must not be used.

Children may need time, and more than one opportunity to develop sufficient trust to communicate their concerns or account, especially if they have communication difficulties, are very young, or are experiencing mental health problems. Additional specialist help may be needed if the child’s first language is not English, is deaf, or has communication difficulties.

The purpose of the interview is to gather information to inform further action. The interview provides an opportunity for the child to express their views, wishes, and feelings. The interviewer must explain what is happening, what may happen next and give appropriate reassurances. However, any choices offered to the child must be realistic and appropriate.

Siblings and children living in the household should always be seen and interviewed unless there is good reason not to do so. Where it is decided not to interview a child, this reason should be recorded.

Consideration should also be given to interviewing any child who has witnessed the abuse of another.

Those conducting the enquiries must seek consent from someone with parental responsibility to enable them to interview a child. In the majority of cases, consent will be sought from, and given by, the parents.

However, there may be exceptional cases where the enquiry team may need to speak to a child without the knowledge of a parent/carer. Relevant circumstances would include:

The possibility that a child would be threatened or otherwise coerced into silence
A strong likelihood that important evidence would be destroyed, or the investigation otherwise impeded; or
That the child does not wish the parent to be involved and is competent to take that decision. In such circumstances, Social Workers should consider seeking legal advice.

INVESTIGATIVE (VIDEO) INTERVIEWS OF CHILDREN

Where it is decided that the interview needs to be video recorded, for use in criminal proceedings, the interview must follow “Achieving Best Evidence in Criminal Proceedings: Guidance for Vulnerable or Intimidated Witnesses including Children.” The interview should be planned and any decisions recorded.

Interviews should be carried out according to the Guidance. Children should not be interviewed in the presence of an alleged or suspected perpetrator of abuse, or someone who may be colluding with the abuse.

A video interview must not be conducted without adequate planning.

A planning meeting should be convened by the Police to determine how the interview should be carried out and to determine any special needs of the child, i.e. an interpreter, specialised help for disability, cultural and ethnicity implications, etc.

MEDICAL EXAMINATIONS

Medical examinations are an integral part of enquiries/investigations. Examinations where possible should take place in suitable surroundings and never in a Police Station. It is desirable that the child or young person is given a say in whether the examination is conducted by a male or female doctor. However, where a choice is not possible, it is the expertise rather than the gender of the doctor that is paramount.

When a child has disclosed abuse to a trusted adult or friend, consideration should be given to enable the confidante to accompany the child to the examination. All children should be given full opportunity to express their wishes and feelings about the pace and process of undertaking an examination and to choose who they would like involved. Examinations should not be ordeals and children should be helped to understand that they are held for their benefit.

CONSENT

When a medical examination or assessment of a child is considered to be necessary, it will normally take place with the informed consent of a parent/carer.

A child may give informed consent for a medical if the child is considered to be of sufficient age and understanding.

If consent is refused, Children and Family Services will need to seek legal advice. Specific consent to obtain a medical examination needs to be referred to in an application for an Emergency Protection Order. However, consent does not pass to the Police or Children and Family Services if the child is taken into Police Protection.

The purpose of a medical examination is:

To diagnose any injury or harm to the child
To document the presence or absence of injury or harm
To provide a report of the findings
To provide a medical opinion of the likely cause of injury or harm within the report
To exclude medical disease as a cause of the observed ‘injuries’.

A medical examination will take place when:

A child presents with a visible injury where there is reasonable suspicion or known to be non-accidental
A child presents with a visible injury with no obvious explanation, or an inconsistent explanation
A child alleges assault.

Medical examination of a child will be the responsibility of a consultant Paediatrician or, exceptionally, a Police Surgeon. The Practitioner must feel confident about performing the examination, as attendance at in Care or Criminal Proceedings is always a possibility. Detailed notes should be taken and written medical reports must be provided.

In cases of physical injury, the medical examination will normally take place on the same day. The workers making the enquiries/investigation will consult with the Consultant Paediatrician who will arrange for the medical to take place.

COLLECTION OF FORENSIC PHOTOGRAPHS

A Police Officer should be present if there are forensic samples to be collected. A Police photographer should be used to photograph injuries unless forensic quality medical photographs have already been obtained. In all cases, there should be a discussion and agreement between the Police Officer involved and the examining doctor.

OTHER SITUATIONS WHERE A MEDICAL EXAMINATION IS REQUIRED

A medical examination should be considered when a child, subject to a child protection plan, presents with an injury.

If a child, subject to a child protection plan, presents at an Accident and Emergency Department the examining doctor will inform the Customer Advice Centre, or the Out of Hours Emergency Service, of the injury.

If there are concerns about the explanation, necessitating the need for a second opinion as to whether the injury is accidental or non-accidental, the Consultant Paediatrician must be consulted.

Following a medical examination in respect of a suspicious injury, the Consultant Paediatrician will consult with Children and Family Services and the Police about the decision for the child to return home. The consultant Community Paediatrician will advise on whether further medical opinion is required, including that of a radiologist.

In cases of suspicious injury where a child has been admitted to hospital, the child should not be discharged without consultation with Children and Family Services, the Police and Consultant Community Paediatrician.

When a child is considered to be at risk from illness, which is fabricated or induced, or neglect, the Community Paediatrician should be consulted to collate the child’s medical records to inform a Strategy Discussion.

CHILD ASSESSMENT ORDERS

All reasonable efforts will be made to secure parental co-operation and proceed with enquiries on a voluntary basis.

Where parents frustrate Section 47 enquiries, but concerns fall below the threshold required for an Emergency Protection Order, Children and Family Services may apply to the court for a Child Assessment Order. The court may direct the parents to co-operate with the assessment of the child’s needs or with specific aspects of the assessment as specified.

OUTCOME OF SECTION 47 ENQUIRIES

All agencies involved with the child should be informed of the outcome of enquiries.

No case that has been opened in response to allegations of deliberate harm to a child should be closed until the following steps have been taken:

The child has been spoken to alone
The child’s parents/carers have been seen and spoken to
The accommodation in which the child is to live has been visited
The views of all the professionals have been sought and considered
A plan for the promotion of the child’s welfare and safeguarding has been agreed.

This information should be recorded on the file.

CONCERNS ARE NOT SUBSTANTIATED

The original concerns may not be substantiated by the enquiries. However, child protection enquiries focus on the welfare of the child, and may identify additional needs and services required to promote the child’s welfare. Children and Family Services, and other agencies, should therefore always consider whether there is a need for support and/or services for the child and their family.

Where concerns remain but there is no substantial evidence, it may be appropriate establish monitoring arrangements as part of the family support services. These should be detailed in the summary of the assessment. Such decisions should be carefully considered and should not be reached as a mean of deferring or avoiding making decisions.

Arrangements for monitoring a case should be clear and include why, what, and by whom the child’s welfare is to be monitored. This should also include a time set for reviewing the arrangements. Parents/carers should be informed of the nature of any ongoing concern.

SUBSTANTIATED, WITH CHILD NOT JUDGED TO BE AT CONTINUING RISK OF SIGNIFICANT HARM

Enquiries may conclude that a child has suffered significant harm, but that there is no ongoing risk of significant harm. In such cases, relevant agencies, may agree that a plan for ensuring the child’s future safety can be developed without the need for a child protection conference. 9.86. It may be judged that a parent/carer or member of the child’s wider family is effectively cooperating with actions to ensure the child’s future safety and wellbeing, and therefore the child is no longer at risk of significant harm. However, this decision can only be made after considering relevant information obtained during the enquiry, and an assessment of the likelihood of successful intervention.

Consideration should always be given to avoiding undue professional optimism in respect of the potential for change.

A plan should be drawn up which answers the following:

What are the intended outcomes?
What actions need to take place?
Who is responsible for those actions?
What is the timescale for review of progress against the intended outcome?
What course of action should be followed if the plan is not being successfully implemented?

A meeting should take place, involving the family and relevant professionals to agree the plan. All parties should sign the agreement. Again, the need for a Core Assessment and the provision of services should be considered.

SUBSTANTIATED AND CHILD JUDGED TO BE AT CONTINUING RISK OF SIGNIFICANT HARM

When it is considered that a child may continue to suffer, or to be at risk of suffering significant harm, Children and Family Services should convene a Child Protection Conference.

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