Child Protection Flashcards
How do you ensure the safety of children?
first concern must be the safety of children. Inform appropriate people if children are at risk of abuse/neglect.
These include:
- Local safeguarding lead
- Police
- Senior clinician
- Social Services
Always remember there may be other children at home who are also at risk and need safeguarding.
What are the provisions surrounding confidentiality in children?
Information sharing should be proportionate to the risk of harm.
Able to share some limited info, with consent if possible, to decide if there’s a risk that would justify further disclosures
What do you do if you’re unsure about whether to share information about a child?
Seek advice from:
1) experienced colleague
2) a named or designated doctor for child protection
3) Caldicott Guardian (senior health professional whose responsibility is to keep patient data secure)
4) professional body (e.g. BMA)
5) defence organisation (e.g. MDU)
6) GMC
How do you balance confidentiality with child protection?
If you suspect a child is about to make a disclosure, you should inform them that you will keep the information confidential, unless they tell you something that you would need to share in order to protect their best interests.
Can children give informed consent?
All children aged 16 or above can be assumed to have capacity.
Children under the age of 16 can consent to treatment/investigations if they are deemed to be Gillick competent.
A child is deemed Gillick competent if they can understand, retain, weigh up the information, and communicate the decision as well as having an understanding of the benefits, risks and consequences.
When do you involve a child’s parents?
Even if a child is competent to make a decision to consent to a given procedure/treatment, you should make every effort to encourage the child to involve their parents.
Whatever their involvement, parents cannot override consent given by a competent child.
Can children refuse treatment?
No minor can refuse consent to treatment when consent has been given by someone with parental responsibility or by the court. This applies even if the child is competent and specifically refuses treatment that is considered to be in their best interest.
This is a rare event, you must seek advice from your trust and defence union.
Enforcing treatment on a child against their will poses risks which need to be weighed up against the benefits of the procedure or treatment.
Will need to involve other members of the MDT and an independent advocate for the child.
What are the Fraser Guidelines?
The Fraser guidelines apply specifically to advice and treatment about contraception and sexual health. They may be used by a range of healthcare professionals working with under 16-year-olds, including doctors and nurse practitioners.
How do you use the Fraser Guidelines?
Practitioners using the Fraser guidelines should be satisfied of the following:
- The young person cannot be persuaded to inform their parents or carers that they are seeking this advice or treatment (or to allow the practitioner to inform their parents or carers).
- The young person understands the advice being given.
-The young person’s physical or mental health or both are likely to suffer unless they receive the advice or treatment.
- It is in the young person’s best interests to receive the advice, treatment or both without their parents’ or carers’ consent.
- The young person is very likely to continue having sex with or without contraceptive treatment.
What are child protection concerns regarding sex?
When using Fraser guidelines for issues relating to sexual health, you should always consider any potential child protection concerns:
- Underage sexual activity is a possible indicator of child sexual exploitation and children who have been groomed may not realise they are being abused.
- Sexual activity with a child under 13 should always result in a child protection referral.
-If a young person presents repeatedly about sexually transmitted infections or the termination of pregnancy this may be an indicator of child sexual abuse or exploitation.
Should you discuss concerns you have over a child’s welfare with their parents?
Discuss concerns you have about a child’s or young person’s safety/welfare with their parents. Only withhold information about your concerns, or about a decision to make a referral, if you believe that telling the parents may increase the risk of harm to the child or anyone else. If this is difficult to judge, or you’re unsure about the best way to approach the situation, ask for advice from a designated or named professional or a lead clinician, or an experienced colleague.
When discussing concerns with parents, explain that doctors have a duty to raise their concerns if they think a child is at risk of abuse/neglect. Explain what actions you intend to take, including if you are contacting the local authority children’s services. Give the parents this information when you first become concerned about a child’s safety or welfare and throughout a family’s involvement in child protection procedures.
Must keep parents informed about what is happening, give them opportunities to ask questions and be willing to answer their questions openly and honestly. Being open and honest with families when concerns are raised about a child’s safety/welfare, and avoiding judgemental comments or allocating blame, can encourage families to cooperate and help children stay with their families in safety. You should give parents information about where they can get extra support and independent advice
What do you do if a child does not consent to disclosure of their information?
If a child does not agree to disclosure there are still circumstances in which you should disclose information, for instance when there is an overriding public interest in the disclosure, when you judge that the disclosure is in the best interests of a child who does not have the maturity to make a decision about disclosure, and when disclosure is required by law.
When considering whether disclosure would be justified you should tell the child what you propose to disclose and why, unless that would undermine the purpose or place the child at increased risk of harm, ask for consent to the disclosure if you judge the person to be competent to make the decision, unless it is not practical or appropriate to do so, e.g. it would be inappropriate to ask for consent if you have already decided that a disclosure is likely to be justified in the public interest.
Sometimes, children who lack the capacity to consent will share information with you on the understanding that their parents are not informed, you should usually try to persuade the child to involve the parent in such circumstances. If they refuse and you consider it to be necessary in the child’s best interests for the information to be shared, you can disclose the information to parents or to the appropriate authorities. Record your discussions and reasons for sharing.
Should you ask for consent before sharing confidential information surrounding child abuse issues?
You should ask for consent before sharing confidential information unless there’s a compelling reason for not doing so, e.g. a delay in sharing information would increase the risk of harm to the child, asking for consent may increase the risk of harm to the child, you have already decided that disclosure is justified in the public interest.
Should ask the child for consent if they have the capacity to give it, if not you should ask a person with parental responsibility. Should also ask for consent from adults you want to share information about. When asking for consent, explain why you want to share information and how it will benefit the child. You should also explain what information you will share, who you will share it with, how the information will be used and where they can seek independent advice & support.
You can share confidential information without consent if it’s required by law, or directed by a court, or if the benefits to a child that will arise outweighs both public and individual interest in maintaining confidentiality. Weigh the harm likely to arise from not sharing the information against the possible harm to the person and to the trust between patients and doctor.
If a child with capacity or a parent objects to information being disclosed, you should consider their reasons and weigh the possible consequences of not sharing the information against the harm that sharing the information might cause. If a child is at risk of, or is suffering from abuse or neglect it will usually be in their best interest to share information.
If you share information without consent you should explain why you have done so to the people the information relates to, and provide the relevant information about what is shared, unless doing this would put the child or anyone else at increased risk. You must record your decision.
How do you deal with conscientious objection?
If carrying out a particular procedure or giving advice about it conflicts with your religious or moral beliefs, and this conflict might affect the treatment or advice you provide, you must explain this to the patient and tell them they have the right to see another doctor. You should ensure that information about alternative services is readily available to all patients. Children may have difficulty in making alternative arrangements themselves, so you must ensure that arrangements are made for another suitably qualified colleague to take over your role as soon as possible.
