Transcript Slide 1

Child Protection in Primary Care
Protecting Children from Abuse
and Neglect
Dr K. Lamb
GP in Harpenden and named GP for
child protection for West Herts PCT
Aims
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Consider the recognition of child abuse in
primary care
Improve understanding of risk factors for child
abuse in families
How to do a child protection referral
Consider aspects around sharing of
information about children
Brief understanding of the extent of the
problem
Raise awareness of how considering child
abuse affects your practice
RCGP child protection - curriculum
statement
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GP must identify abuse, safeguard children from harm,
know how to refer and work with others to protect
children
The welfare of the child in a family is paramount – may
challenge ethical norms
GP must recognise children at risk eg developmental
delay and failure to thrive
GP must recognise children in special circumstances
eg with family history of mental illness
GP must be aware of local referral guidelines and
support parents to reduce risk
GP must consider the physical, psychological and
social aspects of health in children and young people
reference
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Hertfordshire child protection handbook
Bedfordshire CP guidance at
www.bedfordshire.gov.uk
Luton CP guidance at www.luton.gov.uk
InnovAIT vol 1 Iss 1 January 2008
What to do if you’re worried a child is being
abused – Every child matters
www.everychildmatters.gov.uk
GMC – 0-18 yrs: guidance for all doctors
Why me ???
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Child protection fails not just because of failure
of recognition. It fails also because of
problems of record keeping, communication
and failure to follow procedure- these areas
involve the whole practice team, not just the
clinicians
 CSF are the lead agency (in Herts and social
services in Luton and Beds) once child abuse
has been confirmed, but we all have
responsibility for keeping children safe
Why do we find it so difficult?
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This is a distasteful and unpleasant subject
We find it difficult to believe that an adult can
deliberately harm a child
We may find it brings back forgotten
unpleasant memories of our own childhoods
Adults who deliberately harm children may be
deceptive and manipulative individuals
Fear of consequences to ourselves – breaking
confidentiality, the legal implications
Fear of reprisal
Jigsaw
Laming Inquiry into death of Victoria
Climbie – primary care:
Child protection training for GPs
 Training for primary health care team
and all GP staff
 Protocols and procedures and referral
guidance
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Vulnerable children, children in need,
children in need of child protection and LAC
All children-12 million
Vulnerable children, 4 million
Children in need 400,000
Looked after children 53,000
Children in need of child protection-30,000
Case – fictional!
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Samantha is 19 yrs old and the mother of Jade
aged 1 yr. Samantha was a Looked after Child
and spent her adolescence in a children’s
home. She suffered abuse as a young child at
the hands of her natural father. Her baby,
Jade, is 1 yr old. She was born at 30 wks and
spent 6 wks on SCBU. She is known to suffer
from mild developmental delay. She first sat
unaided at around 10 mths. Her speech and
language skills are also delayed.
History - continued
When Samantha was in the children’s home
she was a very troubled young person. She
was referred to the child and family clinic
because she regularly self harmed by cutting.
She also experimented with drug use having
binges of drinking but also using cannabis and
ecstasy. Her current drug habit is not known.
 She has a sister who also has a baby but the
child is on the child protection register
because her sister’s boyfriend was violent to
her.
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History continued
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Samantha lives in a 1 bedroom council
flat on the 3 rd floor with no lift. She has
been housed in an area where she has
no immediate contact with any family
members or friends. The flat is heated by
gas central heating but the meter has to
be cash fed. She is struggling with
managing her finances.
task
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Divide into 4 groups
1 group review the case and decide which risk
factors for abuse are present
1 group consider factors related to children
that increase risk of abuse
1 group consider factors relating to parents’
capacity to adequately parent that increase
risk of abuse
1 group to consider factors in a child’s wider
environment that may increase abuse risk
Task
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Take 10 minutes to discuss this and then
we will feed back
Child factors influencing vulnerability
Pre-term birth
 Congenital abnormality
 Learning difficulty
 Chronic illness or disability
 Unwanted child
 Difficult child eg behaviour
problems/crying
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Factors affecting parenting capacity
Mental health problems
 Substance and alcohol abuse
 Domestic violence
 Learning difficulty
 Social exclusion or isolation
 Abuse in childhood
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Environmental and wider family
issues
Unemployment/financial problems
 Family’s integration into community
 Extended family support networks
 Unsupportive school
 Dysfunctional community
 Cultural/language issues
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Discussion
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What can we do to support Samantha
and Jade as their GP?
Support
Social support – financial advice, home start,
voluntary support eg charitable donations for
equipment.
 Support for mother – mental
health/counselling, drug and alcohol support,
parenting classes, perhaps available at Sure
Start children’s centre
 HV input, assessment at child development
centre, toddler groups eg opportunity class for
children with developmental problems
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Types and definitions of child abuse
Physical
 Emotional
 Sexual
 Neglect
 i.e. acts as well as omissions
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Group discussion
Divide back into 4 groups
 Consider the presentation of the different
types of child abuse in primary care
 Each group to consider each of the 4
definitions separately
 Feed back in 10 mins
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The case continued
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Samantha has come down to surgery with
Jade as an urgent extra at the end of Friday
evening surgery. She is at her wits end. She
has been self harming again and shows you
superficial cuts on the dorsum of the forearm.
 Jade has a bad URTI and on examination of
her chest you notice a bruise in the axilla.
Samantha says that she fell over a toy when
trying to crawl.
Making a referral
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Use CSF form – Herts/CAF in Bedfordshire
Beds and Luton have separate contact
numbers
Refer to local resources for advice
Consider ‘what if’ conversation if uncertain
Seek advice from others – Named Nurse,
Named Doctor, Designated Doctor
Record in child’s records
Herts form and fax number
Form = CSF 3155H
 Fax to 01438 737402 – number at top of
form
 Have ‘what if’ conversation 01438
737500 and ask to have child protection
‘what if’ conversation.
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Bedfordshire contact details
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Intake & Assessment Team (North)
Telephone: (01234) 223599
Intake & Assessment Team (South)
Telephone: (01582) 818499
Bedfordshire Police
Telephone: (01234) 841212
NSPCC 24 hour Child Protection Helpline
Telephone: 0808 800 5000
Complete a Common assessment framework
form for the child
Luton contact details
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Initial Assessment Team, Children &
Learning Department
 Unity House, 111 Stuart Street, Luton, LU1
5NP
Tel: 01582 547653
Fax: 01582 547734, Out of Hours Emergency
Contact: 0870 2385465
Send us an email
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Considering the original case
What information will you provide to
social services?
 What are your obligations about sharing
information?
 What are the risks and benefits of
information sharing?
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Common Assessment Framework
(CAF)
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New system for joint assessment to avoid
duplication of effort
Like elderly care single assessment
Form available from www.ecm.gov.uk/caf
To be used to access services for child in need
not for child protection referral.
Useful format for CP conference report
ContactPoint is govt software holding a
database of all children’s demographics – will
be used to link information about children
Summary of key principles for
information sharing
Practitioners must
 Openly and honestly explain what, how and why
information will be shared
 Always consider a child’s safety and welfare when
making decisions about sharing information
 Seek consent, but if not secured, this should be
respected where possible - unless there is sufficient
need to over-ride the lack of consent
 Seek advice where in doubt
 Ensure information is accurate, up to date, necessary,
shared with the appropriate people and stored safely
 Record the reasons for the decision – whether it is to
share information or not.
Information sharing
Information should be shared with
consent unless so doing increases risk of
significant harm
 The information shared should be
proportionate
 Should be legal
 The child’s welfare is paramount
 Reasons for sharing or not sharing
information should be recorded
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Information sharing without consent
In the public interest
 Where there is evidence a child is
suffering or at risk of suffering significant
harm
 Where there is reasonable cause to
believe a child is suffering or at risk of
suffering significant harm
 To prevent significant harm through
detection etc of crime
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Handout 3
Return to your 4 groups
 Consider the vignettes described
 Feed back after 10 mins
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Incidence of child abuse in UK
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100 children die each year from abuse
Infants under 12 mths are 4 times more likely
to be victims of homicide than the rest of the
population
One infant is killed every 2 wks
3 per 1,000 children under 18 suffer severe
abuse
All figures recognised to be underestimates.
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Nspcc figures
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Prevalence of child abuse
NSPCC study in 2000, 2,899 young
people aged 18-24 were interviewed:
 7% suffered serious physical abuse
 6% suffered serious neglect
 6% suffered serious emotional abuse or
psychological maltreatment
 3% suffered serious sexual abuse within
the family
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The Way Forward
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Improved education and training
 Knowing when to seek information and advice
 Knowing where to seek information and advice
 Knowing where to find support
 Never ‘assume’ that someone else is taking action
 Improved record keeping including records of
telephone calls
 If in doubt – ask someone: don’t keep your worries to
yourself
 Develop a practice protocol
Thank you
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