3.4 Child Protection Assessments and Core Assessments

Section 7 of this chapter, which relates to Single Agency or Joint Enquiry/Investigations, was revised in February 2009 - to include the detailed thresholds and criteria for single and joint agency investigations; these were previously set out in a separate Protocol between the Thames Valley Police and the County Council, which has now been removed from the manual.

Duty to Undertake a Child Protection Assessment
Purpose of a Child Protection Assessment and Timescale
Decision to Undertake a Child Protection Assessment
Emergency Protective Action
Obligations and Responsibilities of All Agencies
Integration with Core Assessment and the Assessment Framework
Single Agency or Joint Enquiry/Investigation - Criteria and Thresholds
Seeing and Interviewing the Child
Parental Involvement and Consent
Medical Assessments
Outcome of the Child Protection Assessment
Discontinuing a Child Protection Assessment
Recording the Child Protection Assessment
Feedback on Outcome of the Child Protection Assessment
Resolving Professional Differences

1. Duty to Undertake a Child Protection Assessment

The local authority’s Children, Young People and Families have a statutory duty to carry out a Child Protection Assessment under Section 47 of the Children Act 1989 in any of the following circumstances:

Where there is information to indicate that a child has suffered or is likely to suffer Significant Harm
Where a child is subject to an Emergency Protection Order
Where a child is subject to Police Protection
Where a child under 10 is in breach of a Curfew Order

The responsibility for undertaking Child Protection Assessments lies with the local authority for the area in which the child lives or is found, even though the child is ordinarily resident in another local authority’s area.

Where a Child Protection Assessment is to be conducted in relation to a child who is ordinarily resident in the area of another local authority, her/his home authority should be informed as soon as possible, and be involved as appropriate in the Strategy Discussion/Meeting. In certain cases, it may be agreed that the home authority should undertake the Child Protection Assessment (for example where the child is Looked After) and in all cases, the home authority should take responsibility for any further support of the child or family identified as necessary.

2. Purpose of the Child Protection Assessment and Timescale

The purpose of the Child Protection Assessment is to determine whether any further action is required to safeguard and promote the welfare of the child or children who is/are the subject of the Assessment.

If a decision is made that a Child Protection Assessment is necessary, it will be conducted by Children, Young People and Families alone or jointly with the Police – see Section 7, Single Agency or Joint Enquiry/Investigation - Criteria and Thresholds.

Where a Child Protection Assessment determines that an Initial Child Protection Conference should be held, the Conference must be held within a maximum of 15 days of the Strategy Discussion/Meeting or the last Strategy Discussion/Meeting where more than one has taken place.

3. Decision to Undertake a Child Protection Assessment

Children, Young People and Families unit managers have the responsibility, based on available information, to authorise Child Protection Assessments.

Child Protection Assessments are normally conducted by the local Children, Young People & Families Assessment Team. Child Protection Assessments concerning children who already have an allocated social worker will be conducted by the allocated social worker and managed by the Assessment Team unit manager.

The decision to initiate a Child Protection Assessment is usually taken at a Strategy Discussion. However, the manager may authorise a Child Protection Assessment at any time whenever the criteria set out in Section 1, Duty to Undertake a Child Protection Assessment are met, for example:

at the point of a Referral,
during the early consideration of a Referral,
during an Initial Assessment or Core Assessment or
at any time in an open case when the criteria are satisfied.

In any such case, a Child Protection Assessment must start with a Strategy Discussion.

In reaching her/his conclusion as to the justification for a Child Protection Assessment, the manager must consider the following variables:

The seriousness of the concern/s
The repetition or duration of concern/s
The vulnerability of the child (through age, developmental stage, disability or other pre-disposing factor e.g. whether they are Looked After)
The source of the concern/s
The accumulation of sufficient information
The context in which the child is living - e.g. whether there is a child in the household who is already subject to a Child Protection Plan
Any predisposing factors in the family that may suggest a higher level of risk e.g. mental health difficulties, substance misuse of parent/carer or domestic abuse

The Child Protection Assessment may be undertaken jointly with the Police - see Section 7, Single Agency or Joint Enquiry/Investigation - Criteria and Thresholds.

Any decision made after a Strategy Discussion that further child protection action by Children, Young People and Families and/or the Police is not necessary as there is insufficient evidence of risk of Significant Harm to the child may only be made providing it is agreed by the Children, Young People and Families Services Assessment Team unit manager and the Officer in Charge of the Thames Valley Police Child Abuse Investigation Unit and the reasons recorded. In such cases, consideration should still be given to the child and family’s needs for support services under a Child in Need Plan and/or a Family Support Conference and/or a Family Group Conference.

4. Emergency Protective Action

Where there is a risk to the life of a child or the likelihood of serious immediate harm, the Police officer and/or social worker must act quickly to secure the immediate safety of the child.

The agency taking protective action must always consider whether action is also required to safeguard other children in the same household or in the household of an alleged perpetrator or elsewhere.

Emergency action may be necessary as soon as the referral is received or at any point during involvement with children, parents or carers, where there is evidence that the risk to the child is sufficiently acute. The need for emergency action may become apparent only after time as more is learned about the circumstances of a child or children. Neglect, as well as abuse, can pose such a risk of Significant Harm to a child that urgent protective action is needed.

Responsibility for immediate action rests with the local authority in whose area the child is found, but should be in consultation with the local authority where the child is ordinarily resident, if different. See Children Moving Across Boundaries Procedure

Immediate protection may be achieved by:

An alleged abuser agreeing to leave the home
Voluntary agreement for the child or children to move to a safer place
Application for an Emergency Protection Order (EPO)
Removal of the child or children under Police Protection
The removal of the alleged abuser, for example through the enforcement by the Police of a Court Order (Sexual Offences Prevention Order or Risk of Sexual Harm Order) made under the Sexual Offences Act 2003 or an Exclusion Requirement attached to an Emergency Protection Order or an Interim Care Order
Gaining entry to the household under police powers

Planned immediate protection will normally take place following an immediate Strategy Discussion between the Police, Children, Young People and Families and other agencies as appropriate. Where a single agency has to act immediately to protect a child, a Strategy Discussion should take place as soon as possible after such action to plan next steps.

The social worker must obtain legal advice before initiating legal action and seek the agreement of her/his manager before an Emergency Protection Order is applied for.

Children, Young People and Families should only seek the assistance of the Police to use their powers of Police Protection in exceptional circumstances where there is insufficient time to seek an Emergency Protection Order or other reasons relating to the child’s immediate safety.

5. Obligations and Responsibilities of All Agencies

All agencies have a duty to assist and provide information in support of Child Protection Assessments. This may be in the context of an assessment under the Common Assessment Framework having been completed.

Any checks made by Children, Young People and Families and/or the Police with other agencies should be undertaken directly with involved professionals and not through messages with intermediaries.

The relevant agencies should be informed of the reasons for the Child Protection Assessment, whether or not parental consent has been obtained and asked for their assessment of the child in the light of the information presented.

6. Integration with Core Assessment and the Assessment Framework

A Core Assessment must be commenced whenever a Child Protection Assessment is initiated. The Core Assessment must be completed within 35 working days of the Strategy Discussion, but can be concluded sooner, for example where an Initial Child Protection Conference or Family Support Conference or Family Group Conference is convened following the Child Protection Assessment.

The Child Protection Assessment should begin by focusing primarily on the information identified during the Referral and Initial Assessment, which appears most important in relation to the risk of Significant Harm.

The assessment of risk will:

Identify the cause for concern
Evaluate the strengths and weaknesses of the family
Evaluate the risks to the child or children
Consider the child’s or children’s needs for protection
Consider the ability of the parents and wider family and social networks to safeguard and promote the child’s welfare
Determine the level of intervention required both in the immediate and longer term

Any contact with the child and family must take into consideration any needs arising from their culture, ethnicity, religion, first language - and provision made accordingly.

This will inform the Core Assessment, which should cover all relevant dimensions in the Framework for the Assessment of Children in Need and Their Families and be alert to the potential needs and safety of siblings or other children in the household or with whom the alleged offender may have had contact.

The Child Protection Assessment/Core Assessment should be led by a qualified and experienced social worker from Children, Young People and Families, who will be responsible for its coordination and completion. The social worker must consult with other agencies involved with the child and family in order to obtain a fuller picture of the circumstances of all children in the household, identifying parenting strengths and any risk factors. All agencies consulted are responsible for providing information to assist with the assessment process.

At the same time, where there is a joint enquiry/investigation, the Police will have to establish the facts about any offence that may have been committed against a child and collect evidence - see Section 7, Single Agency or Joint Enquiry/Investigation - Criteria and Thresholds.

Enquiries and assessment should always involve separate interviews with the child and, in the majority of cases, the parents, and the observation of interaction between the parent and child. Any discussions with children should be conducted in a way that minimises distress; leading or suggestive communication must be avoided and interviews must follow the Achieving Best Evidence guidance - see Sections 8, Seeing and Interviewing the Child and Section 9, Parental Involvement and Consent.

Where the child is too young to be interviewed or verbal communication is difficult for any reason, alternative means of understanding the child’s wishes and feelings should be used. Specialist services may be required in order to assist in communicating with the child (e.g. where the child has a learning difficulty).

7. Single Agency or Joint Enquiry/Investigation - Criteria and Thresholds

The Strategy Discussion/Meeting will decide if a Child Protection Assessment is to be single agency or will run concurrently with the Police investigation concerning possible associated crimes.

The following criteria are a guide to such decisions and judgement must be exercised in individual circumstances. Some cases will not be clear at the outset. Consultation and negotiation must take place between the two agencies and a plan of action agreed according to the circumstances.

7.1 Criteria for Joint Investigation

A joint investigation will always be undertaken whenever it is alleged or suspected that one of the offences described below has been committed or attempted against a child:

any sexual offence committed against a child of either gender, where the child is under 18 years of age and where the suspected abuser is within the child’s extended family and friend network
serious cases of cruelty which amount to a criminal offence under section 1 Children and Young Persons Act 1933. These offences include where a child or young person is assaulted, ill treated, neglected, abandoned or exposed to moral danger
alleged or suspected cases of serious physical injury against a child under 18 years. This includes murder, manslaughter, any assault involving actual or grievous bodily harm and repeated assaults causing minor injury
where the alleged abuser is not part of the family or friends network but has unsupervised access to the child e.g. baby-sitter, voluntary group leader or a professional with responsibility for children.
organised and institutional abuse cases* - see Complex (Organised and Multiple) Abuse Procedure

· fabricated or induced illness cases* - see Fabricated or Induced Illness Procedure

*must be reported to Senior Managers

Following a full assessment of the available facts, the Police and/or Crown Prosecution Service may decide at any stage to terminate a criminal investigation and should inform the social worker of the decision immediately and then follow this up in writing.

7.2 Criteria for Single Agency Investigations

The following cases will normally be progressed as a single agency investigation/assessment by the Police or Children, Young People and Families but the arrangements for the exchange of relevant information should be clarified and involvement in a Strategy Discussion/Meeting may be appropriate. If, at any point during the Child Protection Assessment, it becomes apparent that the joint enquiry/investigation criteria are met, Children, Young People and Families should contact the Police - or vice versa - and a further Strategy Discussion should be held to consider the planning of the joint agency enquiry/investigation.

Social workers will therefore need to be aware of the need to:

keep accurate and contemporaneous notes of any interviews
assess the child’s willingness and ability to pursue a criminal complaint

Police Single Agency Investigations

· Allegations of childhood abuse made by adults (NB any current risks to children should be referred to Children, Young People and Families)

· Where the alleged abuser is not known to the child or the child’s family (i.e. stranger abuse) unless other child protection concerns arise (i.e. where the alleged abuser may pose a threat to the welfare of other children).

During a single agency police investigation, the investigating officer must consider the ongoing needs of the child and family and the possible need to refer to Children, Young People and Families for family support services.

If during the course of a Police investigation, a risk to other children is identified, the need for a joint enquiry/investigation should be discussed with Children, Young People and Families.

When a single agency police investigation occurs outside of office and emergency action is taken to protect the child and preserve evidence the Emergency Duty Team must be informed as soon as possible and a joint investigation considered.

Children, Young People and Families - Single Agency Investigations

Emotional Abuse
Minor injuries to a child in circumstances which amount to poor parenting.
cases of neglect which fall short of a criminal offence resulting from inappropriate supervision or poor parenting skills.
indirect suspicions or concerns arising from over sexualised behaviour
Presence of a person previously convicted of offences against children (a Person Posing Risk formerly often referred to as Schedule 1 Offender).

The criteria for single agency intervention give Children, Young People and Families scope to undertake single agency enquiries in cases where a child has suffered very minor physical injury to avoid unnecessary police involvement in cases of poor parenting. However care is needed where what appear to be one-off minor injuries may be part of a pattern of more serious abuse. Minor injuries caused to a child already subject of a Child Protection Plan or Looked After by the local authority should always be considered for joint investigation

The legal definition of actual bodily harm includes bruising and / or mental trauma. Whilst parents have the right to inflict moderate and reasonable physical punishment on their children, (this is a common law defence to assault, known as ‘reasonable chastisement’), such punishment should not involve bodily harm.

In all cases of minor injury the circumstances surrounding the incident must be considered. Where one or more of the following conditions are present joint agency intervention should be considered:

Vulnerability due to age and/or special needs of the child or other children in the household
A history of minor injuries to the child or other family members (including domestic violence or abuse)
The intent of the assault gives serious cause for concern (e.g. attempted strangulation may leave no marks but is obviously very serious).
A weapon or implement was used
There are previous or ongoing concerns
Parental drug/alcohol abuse or mental health problems etc
The parents account is inconsistent with the injury
Unusual circumstances are present or suspected such as organised or institutional abuse, bizarre behaviour or medical conditions (as may be found in a case of fabricated or induced illness)
The child wishes to complain to the other agency (if age appropriate)

Note: Notwithstanding the criteria set out above nothing shall prevent a joint agency investigation taking place where the circumstances of the particular case indicate it would be prudent to do so.

7.3 Resolving Differences of Opinion

Disagreement about whether a joint or single agency investigation should take place should be resolved by agreement between managers of the two agencies involved. Such considerations should be assessed at the Strategy Discussion/Meeting where most decisions regarding any proposed action should be made.

8. Seeing and Interviewing the Child

8.1 Seeing the Child

All children within the household must be directly communicated with during a Child Protection Assessment either by the Police or Children, Young People and Families or both, to enable an assessment of their safety to be made.

The children who are the focus of concern should be seen alone, subject to their age and willingness, preferably with parental permission (see Section 9, Parental Involvement and Consent).

Children of an appropriate age and understanding should be told what is to happen and given any written information as appropriate.

Their agreement to the process should be sought (see Paragraph 8.4.1 in relation to video interviews) and any non-agreement on their part should be respected.

It may be necessary to provide information to the child in stages and this must be taken into account in planning the Child Protection Assessment.

Explanations given to the child should be brought up to date as the Child Protection Assessment progresses. In no circumstances should the child be left wondering what is happening and why.

Specialist help may be needed if:

The child’s first language is not English
The child appears to have a degree of psychological and/or psychiatric disturbance but is deemed competent
The child has a physical/sensory/learning disability
Where those investigating do not have adequate knowledge and understanding of the child’s racial religious and cultural background
Where unusual abuse is suspected, for example Fabricated or Induced Illnesses - see Fabricated or Induced Illness Procedure - or abuse linked to religious or spiritual belief – see Child Abuse Linked to Religious or Spiritual Belief Guidance

The objectives in seeing the child are to:

Evaluate and record her/his appearance, demeanour, mood state and behaviour
Hear the child’s account of allegations or concerns
Observe and record the interactions of the child and her/his carers
See and record the circumstances in which the child is currently living and sleeping and, if different, her/his ordinary residence
Evaluate the physical safety of the environment including the storage of hazardous substances e.g. bleach, drugs
Ensure that any other children who need to be seen are identified
Assess the degree of risk and possible need for protective action
Meet the child’s needs for information and re-assurance

Where there is a need to conduct an investigative interview, see Section 8.3, Video Interviews.

8.2 Inability to access the child

If efforts to see and communicate with the child or children within the timescales agreed at the Strategy Discussion/Meeting are unsuccessful, then the social worker and, where relevant, the Police officer should:

Inform the relevant manager, and seek legal advice as appropriate; and
In consultation with her/his manager, carry out the contingency plan agreed at the Strategy Discussion/Meeting or
Arrange a further Strategy Discussion/Meeting to agree what further action is required including action to trace the whereabouts of the child (if unknown)

8.3 Video Interviews

The aim of the video interview is to obtain a truthful account from the child in a way which is fair, in the child’s interests and acceptable to the Courts. The child and /or parents’ permission to use the video in Family Court or in criminal proceedings in relation to allegations against employees, professionals etc. should also be sought at this point if applicable.

Where an interview is to take place, in order to avoid undermining any subsequent criminal case, any contact with a child prior to the interview must be conducted under Achieving Best Evidence guidance and staff must:

Listen to the child rather than directly questioning her/him
Never stop the child freely recounting significant events
Fully record the discussion including timing, setting, presence of others as well as what was said

Staff conducting the interview must have had appropriate training, unless the need to depart from the guidance has been agreed by the investigating officers and their managers. Any such decisions must be recorded with reasons.

In planning the interview, consideration must be given to the child’s race, culture, language, gender and religion as well as disability or communication needs, and advice should be taken as required from appropriate specialists (see Section 8.1, Seeing the Child).

Consideration should also be given to the gender of interviewers, particularly in cases of alleged sexual abuse.

The video interview must only be undertaken within the parameters agreed at a Strategy Discussion/Meeting, unless there are reasons for altering the plan which have been agreed by the investigating officers and their managers, and the changes to the plan are recorded with reasons.

Children, Young People and Families and the Police must ensure that appropriate arrangements are in place to support the child through the joint enquiry/investigation. An adult – usually a parent, carer, relative or friend - should be identified to accompany and support the child through the process. The most suitable person for the role will be dependent on the circumstances and must take into account the wishes and feelings of the child.

It is essential that the child is never interviewed in the presence of an alleged or suspected perpetrator of abuse or some-one who may be colluding with a perpetrator.

Generally, by adhering to the Achieving Best Evidence guidance, a video interview of a child witness should be acceptable in criminal proceedings and may spare the child from having to recount their evidence in Court. The child will have to be available to attend Court for cross-examination, which is usually conducted by way of video link to the Court. This spares the child witness from the ordeal of giving evidence in the presence of the alleged offender, while preserving the right of the defence to question the child and give the jury the opportunity to observe the child’s demeanour when being cross-examined. The video interview may also be used in family proceedings.

8.4 Consent to the Video Recording of an Interview

8.4.1 The Child’s Consent to Video Interview

The video recording of interviews of children may only be carried out with the consent of the child her/himself.

Prior to the interview taking place, the child must be provided with sufficient information at a level appropriate to her/his understanding to enable her/him to give informed consent.

Such information would include the fact that the video could be shown to a Court instead of the child having to give his/her evidence directly and that, whether a video recording is made or not, he or she might have to attend court to answer questions directly.

In the case of a child who is too young to understand fully, a parent or a person with Parental Responsibility must usually be asked to give consent on behalf of the child – see Paragraph 8.4.2.

8.4.2 The Parent’s Consent to the Video Interview

The consent of a parent or a person with Parental Responsibility is required for interviews of children under 16, unless the following exceptional circumstances exist:

When a child of sufficient age and understanding requests an interview
Where a Court has made an order (Child Assessment Order, Care Order, Interim Care Order or an Emergency Protection Order) with a direction authorising a video interview
When there is evidence that not seeing the child would seriously jeopardise their welfare
When police are able to evidence that contacting a parent would undermine a criminal investigation
In urgent situations where no parent or carer can be contacted

In all cases, legal advice should be sought where there is any doubt about the issue of parental consent and appropriate legal action taken, if required, prior to the interview.

8.4.3 The Court’s Consent to the Video Interview

In all cases where there are ongoing Court proceedings in relation to the child, legal advice should be sought as to the obtaining of the Court’s consent to the interview.

9. Parental Involvement and Consent

9.1 Parental Involvement

Children, Young People and Families have the prime responsibility to engage with parents and other family members to ascertain the facts of the situation causing concern and to assess the capacity of the family to safeguard the child.

In most cases, parents should be enabled to participate fully in the assessment and enquiry process, which should be explained to them verbally and also in writing. Where a parent has additional needs, e.g. arising from a disability, he or she should be offered support to participate in the assessment. If English is not the parent’s first language, an interpreter must be provided.

Consideration should be given to the capacity of the parents to understand the information shared in a situation of anxiety and stress.

The parents should be involved at the earliest opportunity unless to do so would prejudice the safety of the child. The needs and safety of the child will be paramount when determining at what point parents or carers are given information. Parents should be kept informed throughout about the enquiry, its outcome and any subsequent action unless this would jeopardise the welfare of the child. For further guidance on this issue, see the Information Sharing Protocol.

In explaining the process of a Child Protection Assessment to parents, the following points should be covered:

An explanation of the reason for concern and where appropriate the source of information
The procedures to be followed; this must include an explanation of the need for the child to be seen, interviewed and/or medically assessed, consultation about the gender of the medical practitioner where time allows and seeking parental agreement for these aspects of the enquiry – (see Section 9.2, Parental Consent)
An explanation of their rights as parents including the need for support and guidance from an advocate whom they trust (advice should be given about the right to seek legal advice)
An explanation of the role of the various agencies involved in the enquiry and explanation of the wish to work in partnership with them to secure the welfare of their child
The need to gather initial information on the history and structure of the family, the child and other relevant information to enable an assessment of the injuries and/or allegations and the continuing risk to the child to be made
In situations of domestic abuse, the possibility of working with the parents separately – see also Domestic Abuse Procedure
The provision of an opportunity for parents to be able to ask questions and receive support and guidance

9.2 Parental Consent

The social worker must consult her/his manager so that s/he can decide on the basis of available information, whether to seek parental consent to undertake inter-agency checks. This will usually have already been discussed during the Initial Assessment and at the Strategy Discussion/Meeting.

In addition, the social worker must consult his/her manager about whether parental consent should be sought for an interview with and/or medical assessment of a child.

For further guidance on this issue, see Information Sharing Protocol

See also Section 8.4.2 in relation to parental consent to a child’s video interview and Section 10.3 in relation to parental consent to a child’s medical assessment.

If a decision is made not to seek parental permission, the reasons must be recorded and this may include:

Concern that the child would be at risk of further Significant Harm
Serious concern about the likely behaviour of the adult, for example that the child may be coerced into silence or vital evidence may be destroyed
The views of the child who does not want his/her parent to be informed and is competent to make that decision

When it is decided to interview and/or arrange a medical assessment of the child without seeking the consent of the parents, the decision must be endorsed by the social worker’s manager. Legal advice must be taken as to whether any legal action is required before an interview and/or medical assessment can take place, for example, an application for a Child Assessment Order or in more urgent cases, an Emergency Protection Order.

The parent or carer must be informed as soon as practicable and consistent with the best interests of the child.

Where permission is sought but refused, the social worker’s manager must determine whether to proceed, and if so, record the reasons. Where there are reasonable grounds to believe that a child is suffering, or is likely to suffer, Significant Harm, and access is refused, Children, Young People and Families have a duty to apply for:

An Emergency Protection Order, or
A Child Assessment Order, or
An Interim Care Order

unless it is satisfied that the child’s welfare can be safeguarded without doing so.

9.3 Inability to access the child

Inform the relevant manager, and seek legal advice as appropriate; and
In consultation with her/his manager, carry out the contingency plan agreed at the Strategy Discussion/Meeting or
Arrange a further Strategy Discussion/Meeting to agree what further action is required, including action to trace the whereabouts of the child (if known)

10. Medical Assessments

10.1 Strategy Discussion/Meeting

At the Strategy Discussion/Meeting, consideration should be given to the child having a medical assessment.

Most Strategy Discussions concern children who have not undergone a recent medical examination; occasionally the Strategy Discussion is prompted by a medical referral due to a child’s suspected non-accidental injury.

The Strategy Discussion must consider, in consultation with the Consultant Paediatrician, GP or on-call hospital Paediatric Registrar (if not part of the Strategy Discussion), the need for and timing of the medical assessment.

Consideration should be given as to whether other children in the household require a medical assessment.

10.2 Purpose of the Medical Assessment

To treat, investigate and diagnose any injury or harm to the child
To secure forensic evidence as appropriate
To assess the child’s overall health and development
To arrange follow up and review of the child as appropriate
To provide a medical report of the findings, including an opinion as to the possible cause of any injury
To provide reassurance for the child and parent

10.3 Consent for Medical Assessment/Treatment

The following may give consent to a medical assessment:

A young person of 16 and over
A child of under 16 where a doctor considers he or she is of sufficient age and understanding to give informed consent (and is therefore Gillick Competent)
Any person with Parental Responsibility
The local authority when the child is the subject of a Care Order (although the parent/carer should be informed)
The local authority when the child is Accommodated and the parent/carers have abandoned the child or are physically or mentally unable to give such authority
The High Court when the child is a ward of court
A Court as part of a direction attached to an Emergency Protection Order, an Interim Care Order or a Child Assessment Order

Where the child is the subject of ongoing Court proceedings, legal advice should be obtained about obtaining the Court’s permission to the medical assessment.

It is generally good practice to seek the permission of a parent for children under 16 prior to any medical assessment and/or other medical treatment even if the child is judged to be of sufficient understanding to give consent. If this is not considered possible or appropriate, then the reasons should be clearly recorded.

When a child is Looked After and a parent/carer has given general consent authorising medical treatment for the child, legal advice must be taken about whether this provides consent for medical assessment for child protection purposes; (the parent/carer still has Parental Responsibility for the child).

A child who is of sufficient understanding may refuse some or all of the medical assessment.

In emergency situations where the child needs urgent medical treatment and there is insufficient time to obtain parental consent:

The medical practitioner may decide to proceed without consent; and/or
The medical practitioner may regard the child to be of an age and level of understanding to give her/his own consent

In these circumstances, parents must be informed as soon as possible afterwards and a full record must be made at the time.

In non-emergency situations, when parental permission is not obtained, the social worker and manager must seek legal advice - see Section 9.2, Parental Consent.

10.4 Arranging the Medical Assessment

Referrals for a medical assessment should be made by the social worker or police officer.

If the child has a suspected non-accidental injury which is relatively minor in nature (such as a bruise) or a medical assessment of a ‘well’ sibling is required, it may be appropriate to ask the GP to carry out the assessment.

If a child has a significant suspected non-accidental injury/ requires treatment for an injury, the on-call Paediatric Registrar at the Children’s Hospital, John Radcliffe Hospital or at the Horton General Hospital should be contacted.

If there is concern about possible child sexual abuse, the social worker/Police officer should contact the Community Paediatrician at the Children’s Hospital, John Radcliffe Hospital (weekday 9-5) who will arrange an assessment. Out of routine working hours the on-call hospital Paediatric Registrar should be contacted about sexual abuse cases. S/he will discuss the child/young person with the on-call Consultant Paediatrician and arrange an examination as necessary.

Requests for a non-urgent assessment in cases of possible neglect should be arranged through the Community Paediatric Service based at the Children’s Hospital.

With the parent/ child’s permission, photographic evidence may be collected during the medical assessment. If the child/young person refuses to be examined this must be respected and consideration given to arranging the examination at another time.

10.5 Recording of Medical Assessment

At the conclusion of the medical assessment, the Paediatrician/ GP will give a verbal report of the medical findings to the social worker/police officer, followed by a written report.

The written report should include:

Date and place and timing of the examination
Who gave consent and how (child/ parent, written, phone or in person)
A verbatim record of the carer’s and child’s account of the injury, noting any discrepancy/ change of story
Examination findings, including site and size of marks or injuries
Other relevant findings – e.g. developmental/ learning difficulties
Medical opinion of likely cause of injury or harm
Confirmation of the child’s developmental level (especially in cases of neglect)

All reports and diagrams should be signed and dated by the doctor.

If criminal or family proceedings are instituted, the doctor’s report will be filed and served as his/her statement of evidence. The doctor’s attendance at subsequent court hearings may be required.

10.6 An outline of the health assessment for Oxfordshire children where there is a suspicion of sexual abuse

Specially trained paediatricians examine children where there is a suspicion of sexual abuse. The examination may be requested by the police, social worker or the child’s GP.

Details of Assessment

The health assessment usually takes place at the Community Paediatric Department, Children’s Hospital, John Radcliffe Hospital, Oxford. The paediatrician is sometimes accompanied by a junior doctor; in a few cases a Forensic Medical Examiner (GP with special training) is also present.

The paediatrician firstly obtains a brief history of what is known to have happened from the police or social worker accompanying the family; the child/young person and parent stay in the waiting area while this is happening.

The assessment of the child begins by the paediatrician asking the parent and/young person for consent to the examination. Details of the incident and the child’s medical history are then obtained. Some parents prefer not to have the child in the room when they are recounting the abusive episode, in which case it is helpful to bring a friend or relative to the assessment who can stay with the child in the waiting area.

The child is then examined. A general examination is done first (the paediatrician listens to the heart and lungs, examines the skin, ears, mouth, eyes, arms and legs and feels the abdomen), and the child’s weight and height are measured. The genital and anal regions are then inspected. These areas may be visualised with the colposcope (a machine which provides magnification and a good light source). Photographs or a CD recording of the genital and anal area may be taken (photographs or a CD recording provide a good record of what was seen and help to avoid repeat examinations). The photographs/slides/CD recordings are anonymised and stored securely as are the medical notes. Swabs (like cotton buds) may be used to collect samples from the genital and anal regions. During the genital examination the paediatrician may wear gloves (this is to avoid contaminating samples).

The paediatrician explains the findings to the parent and child and, if there is to be a referral to another specialist or doctor for treatment or advice, the reasons for this. Any queries that the parent or child have are answered. The paediatrician may arrange to review the child at a later date in clinic.

When the assessment is complete the paediatrician explains the findings to the police or social worker.

The paediatrician writes a report for the Police and/or Social Worker and in every case writes to the child’s GP.

11. Outcome of the Child Protection Assessment

The Child Protection Assessment is concluded at the point when, after discussion with all those who have been significantly involved, an informed decision is made as to whether the child is at continuing risk of Significant Harm or not. The decision must take account of all the available information and must have the objective of achieving the best outcome for the child.

The Child Protection Assessment will result in one of four possible outcomes:

Child protection concerns are substantiated and the child(ren) is (are) considered to be at continuing risk of Significant Harm, in which case an Initial Child Protection Conference will be convened.

The Initial Child Protection Conference must take place within a maximum of 15 days of the Strategy Discussion where the decision to initiate the Child Protection Assessment was made
Child protection concerns are substantiated but the child is not judged to be at continuing risk of Significant Harm, because the child, the parents and carers are willing and able to work with professionals to reduce risks and promote the child’s safety and welfare and it is agreed between the agencies involved and the child and family that a plan for ensuring the child’s future safety and welfare can be developed at a Family Support Conference or Family Group Conference without the need to convene an Initial Child Protection Conference.

The option of a Family Support Conference or a Family Group Conference as an alternative to a Child Protection Conference will not be appropriate where there has been serious Physical Abuse or Fabricated or Induced Illnesses.
Child protection concerns are substantiated but the child is not judged to be at continuing risk of Significant Harm, for example because the family circumstances have changed since the harm occurred and/or an alleged perpetrator has permanently left the household. In these circumstances, further assessment and/or support services either on a single agency or multi agency basis may still be required, in which case a planning meeting should be held, an appropriate plan developed and a Lead Professional should be identified. The Plan may include monitoring of a child’s progress through the school or health visitor, and a timescale should be set for reviewing the monitoring arrangements.
Child Protection concerns are not substantiated but the enquiries have revealed the child is in need of support services either on a single agency or multi agency basis and/or further assessment are required. In these circumstances, the Core Assessment should continue (if not already completed), at the end of which a planning meeting should be held, a Plan developed and a Lead Professional should be identified.
Child Protection concerns are not substantiated and no further action is required.

In all cases, the outcome should be authorised by the relevant Children, Young People and Families manager.

Decisions and outcomes must be recorded and where an Initial Child Protection Conference is to be convened, the decisions and outcomes must be included in the conference report.

The outcome of any Child Protection Assessment and the reasons for the decisions must be recorded and parents, the child (if appropriate) together with the professionals involved should all receive a copy of this record.

In relation to 3. and 4. above, a planning meeting of involved professionals and family members must be convened to agree what actions should be undertaken by whom and with what outcomes for the child’s health and development. Whether a Child in Need Plan is needed for ensuring the child’s future safety and welfare should be addressed and kept under review. Such a meeting is also important to inform parents about the nature of any on-going concerns.

Whatever process is used to plan future action, the resulting Plan should be informed by the Child Protection Assessment/Core Assessment findings and should set out who will have responsibility for what action, including a timescale for review of progress against planned outcomes.

Where an Initial Child Protection Conference is to be held, the relevant manager in Children, Young People and Families must ensure that the conference is convened within 15 working days of the Strategy Discussion/Meeting, or the last Strategy Discussion/Meeting if more than one has been held. In the meantime, a short term Child Protection Plan must be prepared and implemented giving due consideration to the following:

Can the child be protected at home?
If so, can the Child Protection Plan be agreed with the parents?
If not, can the child be placed with relatives with parental consent?
If not, can the child be placed in foster care with parental consent?
If so, is a voluntary agreement appropriate and sufficient in the circumstances?
Should legal action be considered?
Should the alleged abuser be asked to leave the family home?

12. Discontinuing a Child Protection Assessment

Any decision to discontinue a Child Protection Assessment should be taken by the relevant manager in Children, Young People and Families Services in consultation with the Police (and where appropriate other involved agencies and in particular the referring agency) after checks have been completed, and be taken in a flexible manner when it is clear that the criteria for Child Protection Assessment are not satisfied.

This decision should be authorised and recorded by the Children, Young People and Families manager who should record the reasons and whether the Core Assessment should be completed.

13. Recording the Child Protection Assessment

A full written record must be completed by each agency involved in a Child Protection Assessment, using the required agency pro-formas, signed and dated by staff. A data entry form (CP1) must be completed to notify the Case Conference Administrator by the Children, Young People and Families social worker.

Rough notes must be retained by practitioners until the completion of any anticipated legal proceedings.

Children, Young People and Families recording of enquiries should include:

Agency checks
Contacts made cross-referenced with any specific forms used
Strategy Discussion/Meeting notes
Details of the enquiry
Body maps (where applicable)
Assessment including identification of risks and how they may be managed
Decision making processes
Outcome/Further Action Planned

At the completion of the Child Protection Assessment, the social worker’s manager should ensure that the concern and outcome have been entered on the child’s Chronology.

14. Feedback on Outcome of Child Protection Assessment

Feedback on the outcome of a Child Protection Assessment should be provided to non-professional referrers in a manner that respects the confidentiality and welfare of the child and family.

Information to parents and children should be relayed in an appropriate format and translated for those people whose first language is not English.

Children, Young People and Families should ensure that parents, children (depending on their level of understanding), professionals and other agencies which have involvement are notified in writing of the outcome of Child Protection Assessments within 48 hours of the decision being made.

If there are ongoing criminal investigations, the content of the notification should be agreed with the Police.

15. Resolving Professional Differences

Where there remain differences of views, for example about a decision that an Initial Child Protection Conference is not required, every effort should be made to resolve them through discussion and negotiation.

Where a disagreement cannot be resolved the relevant staff should immediately notify their line managers. The line managers should ascertain the specific circumstances of the disagreement and contact should occur between agencies within 24 hours. The purpose of this contact is to review the available information and to resolve the concern. Where necessary this may involve a meeting between the managers. Any agreed plan arising from this contact should be fed back immediately to the operational staff involved, confirmed in writing between agencies and include a date for review.

End