SCOTTISH EXECUTIVE

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Protecting Children: A Shared Responsibility

Chapter 6: SUSPECTED CHILD ABUSE AND THE ROLE OF HEALTH STAFF IN THE PROCESSES OF PROTECTION

The Referral Process

Referral

All allegations of child abuse or neglect, including anonymous referrals, should be taken seriously. Professionals should consider all cases with an open mind without assuming that abuse has, or has not, occurred. All referrals involving allegations of abuse warrant a carefully considered and measured response. Health professionals must be alert to the possibility of abuse of children in families they already know, whether or not they have been alerted to a specific concern through the referral process as, for example, cases of emotional abuse or physical neglect, may not be easy to recognise at the point of referral.

When a concern relating to the welfare of a child is raised, whether this is a clear allegation of physical or sexual abuse or a more general concern about the possibility of neglect or emotional abuse, professionals must share information with other agencies involved with the child (police, social work and education) before deciding what further action to take. This will ensure that an early assessment of any potential harm to the child can be made leading to a decision whether or not further child protection inquiries are needed. No one agency can make this assessment without full information and consultation with others. Health professionals or other agencies may separately record information about the child and family over time which may retrospectively suggest a degree of concern which had not prompted referral to social work services or the police. Bringing all this information together may indicate a much more serious level of concern about the child's situation requiring further investigation and intervention. The local authority social work service has the statutory duty to protect children, in partnership with other agencies.

Planning Meeting or Discussion (PMD)

Where significant concerns are apparent these early inter-agency discussions should lead into a planning discussion between senior experienced colleagues in the health, social work and police sectors. This Planning Meeting or Discussion will decide what form the child protection inquiries will take, including the medical component of any investigation. In urgent cases this discussion may take place by telephone where there is insufficient time to enable professionals to meet. Planning child protection inquiries should include discussion relating to:

• the nature of the alleged incident and significant background information.
• the timing, venue and type of any medical examination required e.g. a comprehensive or specialist (as detailed later), the need for a forensic component, the need for specialist photographic facilities, colposcopy and possibly video-colposcopy.
• how the child should be prepared and briefed for the whole process, taking into account emotional and health care needs.
• who will accompany the child to the medical examination, which should take into account the wishes of the child and the need, if possible, that this person should not be a potential witness.
• the timing of any joint police and social work interviews.
• who will give consent for medical examination or interview.

Close co-operation between professionals at the beginning of the investigation is crucial to the success of any subsequent intervention, ensuring that all available information and evidence is gathered timeously and its significance interpreted carefully by appropriately trained and experienced staff. Failure to work together in this way may lead to the loss of forensicevidence particularly in cases of sexual abuse and to the potential risk of delaying medical treatment in a physically injured child with unsuspected internal abdominal injuries or intracranial bleeding.

The role of health care professionals in the process is detailed on Chapter 8.

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