Child Protection Medicals Research Articles

Review of the Literature on Child Protection and Domestic Violence Electronic Medical Record Alerts

The aim of this systematic literature review was to identify peer‐reviewed publications on the use and/or evaluation of child protection or domestic violence alerts in electronic medical records. A systematic literature search yielded 751 results, with four articles retained for review. Two articles related to the Child Protection – Information Sharing electronic medical record alert system in England and two articles described a clinical decision‐support alert operating in the background of an electronic medical record system in the emergency department of the Pittsburgh Children's Hospital, Pennsylvania, USA. No articles were identified that described domestic violence electronic medical record alert systems. Child protection electronic medical record alert systems are operating in healthcare facilities in several countries. However, despite their promise in terms of improving healthcare and service coordination for children and their families, research testing the efficacy of these systems is limited.‘Identif[ies] peer‐reviewed publications on the use and/or evaluation of child protection or domestic violence alerts in electronic medical records’Key Practitioner Messages Child protection alerts in electronic medical records are used in a number of countries. No published examples of the use of domestic violence alerts in electronic medical records could be found. Alerts on linked electronic medical records can convey standardised, current, clinically significant information to a multitude of clinicians across several health services at once. Two evaluation studies of a child protection electronic medical record alert system were found; therefore, more evaluation studies are required.

G53(P) Listening to children and young people – the voice of the child in child protection medicals

Background The RCPCH Child Protection Companion 2013 states ‘Record in quotes and verbatim. Record your questions, verbatim’. Nurses have a long history of acting as advocates for children ensuring that children’s and young people’s voices are heard in relation to their health, well-being and care. Children who had experience of the child protection system themselves ‘voiced the importance of being heard separately from their parents and being listened to’ (Munro, 2011). Aims To examine whether the voice of the child was being heard and documented in our child protection medical reports. Method All typed child protection medical reports by community paediatricians from January 2014 to November 2014 for children age 6 and above were examined (excluding child death). Evidence in reports fell into 4 categories. Documentation that the entire history was obtained from the child, negating the need for quotation marks. Dialogue quoting specific questions asked and answers. Selected quotes from the child. Descriptive documentation without quotations e.g. child told me…, he explained… Results 37 medical reports met the criteria. All 37 reports (100%) had one form of documented evidence the voice of the child had been heard. 10 of 37 (27%) reports the history was documented as obtained from the child, and within 3 of these there was also quoted dialogue. 2 of 37 reports (5.4%) contained documented dialogue. 17 of 37 (45.9%) documented selected quotes. 8 of 37 (21.6%) contained descriptive terms only. Conclusions 100% of child protection reports examined had documented evidence that we listened to the voice of the child. There is much variability in how we as paediatricians are documenting this. This variability reflects both the examiner, their experience and personal history taking style, as well as the child, their age, confidence, persons present and simply how much they are willing to share at that time. There should be more joint working and training between Paediatricians and Children’s Nurses to establish secure environments which help children find their voice, specifically in child protection medicals.

G50(P) Sibling child protection (cp) medicals are currently conducted on an adhoc basis: the need for national minimum standards for identification and examination of this vulnerable group

Background There are currently no minimum national standards for conducting sibling CP medicals and few published studies show little consensus amongst healthcare professionals and social services in conducting these medicals. Aims Collation of sibling CP medical information from senior safeguarding clinicians in our region and examination of the child protection database of our NHS Trust with the aim of formulating a local sibling CP medical protocol. Methods First survey: online Survey Monkey was sent out to 40 safeguarding doctors and nurses in our region from Dec 2013–Feb 2014. Second survey: analysis of records of all CP referrals and medicals conducted in 2010 including handwritten CP medical proforma and final typed medical reports completed by Paediatricians in our NHS Trust. Results 25% responded to our Survey Monkey. Majority of respondents said they conducted sibling CP medicals in their organisations. Most respondents (80%) had no protocol to guide their decisions and commented that medicals were normally done on an adhoc basis. In the Trust survey, a total of 178 CP medicals were conducted in 2010. We identified 2 pathways of referrals. All siblings (100) of index cases referred as a family unit (37 families) had a CP medical (100%). 78 children were referred as individual index cases. 48/78 children referred by Social Services as individuals were identified to have siblings. 26/48 index cases who had siblings were identified as having CP concerns. 8/26 index cases were removed from their homes. There was no record (0%) of sibling medicals conducted in any of the 48 index cases with siblings including index cases with CP concerns. Conclusion There is very little consensus on performing CP medicals on siblings of index cases in our region and local Trust. Siblings of index cases referred as individuals did not have a medical even when there were significant CP concerns. Following the 2 surveys, a CP sibling medical protocol to guide local Paediatrician’s decision regarding identifying/conducting medicals has been proposed.

G144(P) Is it a time to consider introducing simulation training for ‘Child Safeguarding’?

BackgroundChild protection medical examination is an essential competency for any trainee to progress through CCT. Often trainees are apprehensive when asked to perform Child Protection medicals. Inadequate training may lead...

G171(P) Vesicular genital lesions in children – is it sexual abuse?

AimThree cases with vesicular lesions in the ano-genital area are presented. In children this presentation always raises concerns of genital herpes and possible sexual abuse. These cases had varied outcomes...

G174(P) A retrospective evaluation of non-acute child protection medicals performed in the last five years in a metropolitan borough in United Kingdom

AimTo identify differences in bruising distribution between disabled and non-disabled children, demographic variables associated with non accidental injury (NAI)IntroductionNAI is classified as: physical, emotional, neglect and sexual abuse. If NAI...

G224(P) Child Abuse Record Keeping and Report Writing Standards (CARRS)

Child protection remains a sensitive issue in the UK and is a challenge to Paediatricians and other health care workers. It is well established that a high quality written report...

G218(P) A Review and Audit of Penetrative and Forensic Child Sexual Abuse Cases

AimsTo review all penetrative child sexual abuse (CSA) cases presenting to a local unit over 12 months and audit against national guidelines for sexually transmitted infection (STI) screening and Forensic...

Audit of child protection medical reports against local child protection procedures

AimsChild protection is currently a particular challenge to paediatricians. Local safeguarding procedures have been developed to guide practice by medical professionals, social care and police. They include guidance on the...