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 NHS HERTS Aims 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 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 (1989 Children Act) – 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 Hertfordshire www.hertssafeguarding.org.uk Luton CP guidance at www.lutonlscb.org InnovAIT vol 1 Iss 1 January 2008 What to do if you’re worried a child is being abused – www.education.gov.uk/publications GMC – 0-18 yrs: guidance for all doctors Working Together to Safeguard Children 2010 RCGP safeguarding children toolkit NICE 2009 – When to consider child maltreatment Why me ??? 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? 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, our personal safety Fear of reprisal High profile cases Jigsaw Laming Inquiry into death of Victoria Climbié – primary care: Child protection training for GPs Training for primary health care team and all GP staff Protocols and procedures and referral guidance 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! Bernadette is 19 yrs old and the mother of Jade aged 1 yr. Bernadette 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 Bernadette 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 the subject of a child protection plan because her sister’s boyfriend was violent to her. History continued Bernadette 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 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 – things that make a child harder to parent 1 group consider factors relating to parenting capacity and what parental factors might increase risk of abuse 1 group to consider factors in a child’s wider environment that may increase abuse risk Task 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 Factors affecting parenting capacity Mental health problems Substance and alcohol abuse Domestic violence Learning disability Social exclusion or isolation – eg teenage parent Abuse in childhood Environmental and wider family issues Unemployment/financial problems Family’s integration into community Extended family support networks Unsupportive school Dysfunctional community Cultural/language issues Discussion What can we do to support Bernadette and Jade as their GP? Support CAF Sure Start Children’s Centre 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 HV input, assessment at child development centre, toddler groups eg opportunity class for children with developmental problems Types and definitions of child abuse Physical Emotional Sexual Neglect i.e. acts as well as omissions Group discussion Divide back into 4 groups Gp 1 to consider physical abuse, Gp 2 to consider emotional abuse, Gp 3 to consider neglect, Gp 4 to consider sexual abuse Work out a definition of the category you are discussing then consider its presentation in primary care Feed back in 10 mins The case continued 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. Bernadette 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. Making a referral Consider the immediate safety of the child – admission needed? Emergency police protection order? Use CSF form – Herts/CAF in Bedfordshire Beds and Luton have separate contact numbers Refer to local resources for advice Seek advice from others – Named Nurse, Named Doctor, Designated Doctor Record in child’s records and mother’s records Herts form and fax number Form = Single service request form. Will move to be web based referral form in near future Fax to 0300 123 4043 TAS - targeted advice service – 01438 737511 for advice if you are still uncertain having sought advice elsewhere first Luton contact details Initial Assessment Team (Duty Desk) - 01582 547653 Emergency Duty Team - 0300 3008123 Public Protection Support Team - 01234 846960 www.lutonlscb.org.uk For information and downloads on CAF/MAFSP process, please follow this link www.luton.gov.uk/caf 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? Common Assessment Framework (CAF) System for joint assessment of children’s/family needs Form available from local safeguarding children board websites To be used to access services for child in need Develops a team around the child – TAC that can support family 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 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 Handout Return to your 4 groups Consider the vignettes described Feed back after 10 mins Incidence of child abuse in UK 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. Nspcc figures 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 C hild abuse can mean a lot of different things such as neglect, physical, emotional or sexual abuse - it's not always easy to know if you or someone you know is being abused. But the important thing to remember is that no-one has the right to hurt you or make you do anything that feels wrong. Here you can find out what abuse means, what you can do to stop it, and who can help you. Please remember - if you or someone you know is being abused in any way, then the most important thing to do is talk to someone about it. You can call ChildLine anytime on 0800 1111 or you can speak to a counsellor online in a 1-2-1 chat. You can also speak to other young people on the Abuse and Safety Message Board. What children say to childline In 2008/09, ChildLine counselled 12,268 children about sexual abuse as their main problem, representing 8 per cent of all calls answered and the fourth largest main reason for children calling ChildLine that year. Between 2004/05 and 2008/09, the annual number of children counselled by ChildLine regarding sexual abuse rose from 8,637 to 12,268, giving an overall increase of 42 per cent. Over the past five years (2004/05–2008/09), the rate of percentage increase for sexual abuse for boys counselled by ChildLine has been proportionately higher (129 per cent) than for girls (14 per cent). Family relationship problems constituted the largest additional problem (23 per cent) affecting children when they called about sexual abuse. The Way Forward 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 Please remember to complete your evaluation forms and leave them with us before you go