Process for Outpatient Medical Assessments where there are Child Protection Concerns

1. Overview

When there is a requirement for a child to undergo a medical assessment at Calderdale Royal Hospital, as a result of  concerns  in relation to abuse or neglect,  ring the Paediatric Consultant for Safeguarding via the switchboard on 01422 357171 between 0900 – 1700 hours Monday - Friday, and the Paediatric Consultant on call via the switchboard on 01422 357171 outside of these hours.

Unfortunately, the hospital is unable to give a definite appointment until the social worker(s)  have visited the child to confirm an examination is definitely needed, and parental consent has been obtained for the medical.

Cases of concern should normally come from Social Care or the Police. GP's may very occasionally require a second opinion prior to actual referral to Social Care. However, in all cases, information on prior concerns should be obtained from Social Care, and Social Care should be aware of the attendance even if they are not actually involved. Social Care will require feedback on the outcome of the second opinion by the Paediatrician within 72 hours of the examination to decide if a Child and Family Single Assessment is required. The Paediatric on-take team will do the usual emergency evaluation of children requiring emergency assessment treatment out of hours.

2. Physical Abuse

0900-1700: Please contact the Calderdale Royal Hospital Switchboard on 01422 357171. You will be referred on to the Paediatric Consultant on call to arrange an appropriate time to attend a Child Protection Medical.

1700 – 0900 and weekends and Bank holidays: Please contact the Paediatric Consultant on call (via hospital switchboard). Paediatric Registrars can provide emergency treatment and assessment and refer on after assessment if necessary.

3. Sexual Abuse

In cases of sexual abuse, follow the West Yorkshire Consortium Safeguarding and Child Protection Procedures. If sexual abuse or sexual violence is suspected, background information should be gathered and a multi-agency strategy meeting must be held.

At the strategy meeting, consideration will be given to Parental Responsibility, Gillick/Fraser competence/social care input and the supportive network needed to ensure an effective examination.

All Child Sexual Abuse assessments are now carried out via Mountain Health SARC (Sexual Abuse Referral Centre). Mountain Health can be contacted on 0330 223 1154.

Children will be seen in the SARC centre in an arranged clinic appointment at the Hazelhurst Centre SARC.

Mon – Sat 10:00 – 18:00, Sundays and Bank Holidays – 11:00 - 16:00

Urgent out of hours cases can be referred to St. Mary’s SARC Manchester.

If it is within 10 days of the last incident: telephone consultation should take place between Police, Social Care and Mountain Healthcare Paediatric Clinicians.

If a forensic examination, acute health needs (such as sexual health) or access to wider sexual violence services is needed, an appointment is made at the SARC. All cases will be seen by a Paediatric examiner and a Paediatric crisis worker.

If over 10 days since the last incident

The disclosure of, or concern for, sexual abuse/assault of child or young person with the last incident occurring over 10 days ago (new RCPCH specification of CSA which changed the acute timeframes to 3 weeks, changing focus from forensic windows to ensuring healthcare needs especially pregnancy risk was considered as some under 13s will be post pubertal.)

Background information acquired and a  multi-agency strategy meeting must be held. 

Appointment is made for assessment at The Hazelhurst Centre SARC.   The child / young person to be seen by a Paediatric Examiner and supported by a Paediatric Crisis Worker.

Onward referral to other agencies as appropriate processed by the Paediatric Admin / Crisis Worker e.g. ISVA / CISVA including Named Doctor and Safeguarding Team.

16’s and above will be seen by the adult service, however under 18s with learning disabilities, complex need or familial abuse should be seen by the Paediatric Examiner.

After each examination, the case will be reviewed by the Paediatric Team. There will be a review of case management which will include ongoing needs and any referrals required. Any after care/ referrals will be completed by the day time Paediatric Admin/ Crisis Worker.

Appropriate quality assurance takes place to ensure that;

• Recording of injuries and documentation meets required standards;
• Assessment wider needs such as CSE, safeguarding and statutory obligations are undertaken;
• Reports and Statements are written with appropriate peer review; and
• Learning from complaints and incidents takes place.

4. The Hospital's Expectations of Agencies

Please ensure that you provide as much background information as possible to the situation such as;

• Name of General Practitioner;
• Birth History;
• Family and Social care History.

It is much more difficult to carry out these examinations without this background information.

Please endeavour that if the parent is not present, there is consent to the examination in writing. In the case of a father, he needs to have Parental Responsibility, to be able to consent.

Please do not use medical staff as technicians only, but involve the Paediatricians in subsequent decision making.

Please use the clinic sessions wherever possible.

Please provide feedback to the Paediatrician regarding movement of case i.e. progression to Child Protection Conference

5. What you can expect from Calderdale Hospital

• A full assessment of the child including a full history and examination;
• A written report of the examination, containing medical opinion;
• Where possible, attendance at subsequent Child Protection conferences;
• A report for Child Protection conference following the findings of the medical which may expand further than the medical report;
• Follow up where appropriate, a referral for therapy etc.