|
|
|
|
Care Plan
The local authority has a statutory duty to prepare a written care plan
for any child looked after by the local authority, in consultation with the
child and his or her family, and other professionals involved. The contents
of a care plan are specified in the Arrangements to Look After Children (Scotland)
Regulations 1996 and include the arrangements made for the child's care, education
and health needs.
Child Protection Plan
An inter-agency Child Protection Plan is made following the child's name
being placed on the Child Protection Register. It is agreed jointly by the agencies
concerned with a child's welfare and co-ordinates the services they provide.
Its aim is to ensure that the child's needs for protection and support to promote
his or her welfare and development are met by all agencies working together.
The plan should specify goals to be achieved, resources and services to be provided,
the allocation of responsibilities, and arrangements for monitoring and review.
Categories of Abuse
Many definitions of abuse are used. The National Commission of Inquiry into
the Prevention of Child Abuse (1996) discussed these. A broad definition was
adopted by the Commission, "Child abuse consists of anything which individuals,
institutions or processes do or fail to do which directly or indirectly harms
children or damages their prospects of safe and healthy development into adulthood".
General definition of abuse - children may be in need of protection where their basic needs are not being met, in a manner appropriate to their stage of development, and they will be at risk from avoidable acts of commission or omission on the part of their parent(s), sibling(s), other relative(s), a carer (i.e. the person(s), while not a parent, who has actual custody of a child), other responsible professionals or complete strangers.
To define an act or omission as abusive and/or presenting future risk for the purpose of registration a number of elements must be taken into account. These include demonstrable or predictable harm to the child which must have been avoidable because of action or inaction by the parent or other carer.
Categories of abuse- for recording all cases the following are the standard categories of abuse (Scottish Office 1992). Although these are presented as discrete definitions, in practice there may be overlap between categories. In such cases local authorities should enter the child's name on the Child Protection Register under one main category of abuse although for the purpose of individual case management, the case conference may identify combinations of abuse categories which the child protection plan will need to address. It may also become necessary to change the category of abuse under which a child is registered as a case progresses.
Physical Injury
Actual or attempted physical injury to a child, including the administration of toxic substances, where there is knowledge, or reasonable suspicion, that the injury was inflicted or knowingly not prevented.
Sexual Abuse
Any child may be deemed to have been sexually abused when any person(s), by design or neglect, exploits the child, directly or indirectly, in any activity intended to lead to the sexual arousal or other forms of gratification of that person or any other person(s) including organised networks. This definition holds whether or not there has been genital contact and whether or not the child is said to have initiated, or consented to, the behaviour.Non-Organic Failure to Thrive
Children who significantly fail to reach normal growth and developmental milestones (i.e. physical growth, weight, motor, social and intellectual development) where physical and genetic reasons have been medically eliminated and a diagnosis of non-organic failure to thrive has been established.
Emotional Abuse
Failure to provide for the child's basic emotional needs such as to have a severe effect on the behaviour and development of the child.Physical Neglect
This occurs when a child's essential needs are not met and this is likely to cause impairment to physical health and development. Such needs include food, clothing, cleanliness, shelter and warmth. A lack of appropriate care, including deprivation of access to health care, may result in persistent or severe exposure, through negligence, to circumstances which endanger the child.
Joint Visit
A visit which is carried out by two practitioners from different professions/agencies.
'No Access' Visit
The professional should determine the circumstances which constitute a 'no
access' visit and an agreed procedure should be established. Every 'no access'
visit should be recorded. Typical examples of 'no access' visits are listed
below:
1.The unseen child
A visit where the particular child is not seen even though access is gained and other members of the household interviewed, or when access to the dwelling is denied. Where there is cause for concern prompt action must be taken.2.'No contact' visit
A visit where there is no response and no contact is made with any member of the household.
Record
The record is to provide succinct and objective written evidence of action
taken, advice given, observations made and future intentions of the practitioner
and the patient/client. It should be completed as near as possible to the time
of the contact and be signed and dated by the recorder of the information. Further
guidance for nurses is available in Standards for Records and Record Keeping
(UKCC 1993).
REGISTERS
Child Protection Registers
In each area covered by social work services a central register must be
maintained by that department which lists all the children in the area who are
considered to be suffering from, or likely to suffer, significant harm and for
whom there is a child protection plan. This is not a register of children who
have been abused but of children for whom there is an inter-agency child protection
plan. The registers should include children who are recognised to be at risk
and who are placed in the local authority's area by another local authority
or agency. Registration does not of itself provide any protection and it must
lead to an inter-agency protection plan. Registration should not be used to
obtain resources which might otherwise not be available to the family.
Requirements for Registration
Before a child is registered the conference must decide that there is, or
is a likelihood of, significant harm leading to the need for a child protection
plan. One of the following requirements needs to be satisfied:
i. there must be one or more identifiable incidents which can be described as having adversely affected the child. They may be acts of commission or omission. They can be either physical, sexual, emotional or neglect. It is important to identify a specific occasion or occasions where the incident has occurred. Professional judgement is that further incidents are likely; or
ii. significant harm is expected on the basis of professional judgement of findings of the investigation in this individual case or on researchevidence.
The conference will need to establish so far as they can a cause of the harm or likelihood of harm. This cause could also be applied to siblings or other children living in the same household so as to justify registration of them. Such children should be categorised according to the area of concern.
Lead Clinician/Nurse/Doctor for Child Protection
Each Health Board (HB) should identify a senior doctor and a senior nurse,
normally with a health visiting qualification, but with responsibilities across
the HB to be designated as the senior professional to sit on the CPCs to which
the HB relates.
Reorganisation of local government in 1997 increased the number of local CPCs with whom HBs must liaise. When the HB relates to several CPCs it may be appropriate for the designated nurse/doctor formally to delegate responsibility for some CPCs to named professionals from local Trusts.
Clinical Supervision
A term used to describe a formal process of professional support and learning
which enables the individual practitioners to develop knowledge and competence,
assume responsibility for their own practice and enhance consumer protection
and safety of care in complex clinical situations. It is central to the process
of learning and to the expansion of the scope of practice and should be seen
as a means of encouraging self-assessment and analytical and reflective skills.
Significant Harm
The term 'significant harm' has not been defined in the Children (Scotland)
Act 1995.
In medical usage, the term is used to encompass the extent of immediate and long-term damage resulting from any form(s) of abuse and neglect. It highlights the need to consider not only the degree of impairment/injury at presentation, physical (including growth), sexual, emotional, but also the degree of long-term impairment/disability, physical, intellectual, emotional, social and behavioural, which is likely to result. For example:
1. Considering the degree of significant harm in a shaken baby would include the severity of the presenting illness, indicated to some degree by the level of medical intervention required and the long-term sequelae such as cerebral palsy, seizures and visual impairment.
2. Evaluating significant harm in sexual abuse would include not only genital injury but any accompanying physical injury, the possibility of sexually transmitted disease or pregnancy and short/long-term psychological or psychiatric sequelae.
3. In considering the degree of significant harm, both ill treatment and impairment, and impact on long-term functioning require consideration.
Munchausen Syndrome by Proxy (MSBP)
Munchausen Syndrome by Proxy, or induced illness syndrome, may be defined
as significant harm which is caused to a child by the actions of a parent or
other carer who deliberately fabricates symptoms and/or signs of illness or
induces actual illness in a child which would not otherwise be present.
The actions may be as a result of omission or commission and include such behaviour as:
On the extremely rare occasions when MSBP is strongly suspected, it may be considered necessary and justified for the future health and safety of the child to consider the use of covert video surveillance (CVS). However, the use of CVS is contentious, inter-agency protocols must be in place, agreed by the CPC and the Trust Ethical Committee, before it is contemplated.
|
|
|