Chapter Five

Child Protection Enquiries and Related Criminal Investigations

In this section:

Introduction
The obligations and responsibilities of all agencies
The investigation
The medical assessment
Steps to be take at the conclusion of child protection enquiries

Introduction

The purpose of this section is to establish the obligations and responsibilities of the respective agencies when enquiring into a child who is suffering or likely to suffer significant harm or a child who is ‘in need of support’ (Section 17) where a criminal offence is also suspected. These obligations and responsibilities will be adhered to whether the enquiry is conducted as a single agency enquiry or a joint agency enquiry.

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The Obligations and Responsibilities of All Agencies

5.1 All agencies have a duty to assist and provide information and advice in support of child protection enquiries and criminal investigations. Assessing the needs of a child and the capacity of their parents or wider family network adequately to ensure his/her safety, health and development very often depends on building a picture of the child’s situation on the basis of information from many sources.

5.2 The expectations of other agencies include:

  • Collating and sharing all relevant information (see also Chapter 2 on Information Sharing)
  • Attending or contributing information to strategy meetings if called upon to do so
  • Taking responsibility to update those conducting the enquiries of any developments in the child or family’s situation which have a bearing on the child’s safety or welfare
  • Assisting in monitoring the child and providing additional support

“Some of the worst failures of the system have occurred when professionals have lost sight of the child and concentrated instead on their relationship with the adults. The child should be seen by the practitioner and kept in focus throughout the work with the child and the family. The child’s voice should be heard and account taken of their perspective and views” (Working Together to Safeguard Children 2006)

The Duty to Make Child Protection Enquiries

5.3 Child protection enquiries start when the initial assessment of a child welfare concern by children’s social care concludes that there is “reasonable cause to suspect that a child who lives, or is found, in their area is suffering or likely to suffer significant harm”.

5.4 Children’s social care has the statutory duty to make, or cause to be made, child protection enquiries and is thus the lead agency for these enquiries.

The Duty To Investigate Suspected Criminal Offences

5.5 Child protection enquiries will invariably involve the suspicion that a criminal offence has been committed. Some Section 17 (child in need) enquiries will also involve the suspicion of a criminal offence.

5.6 The police are responsible for the gathering of evidence in criminal investigations. This task can be carried out in conjunction with other agencies but the police are ultimately accountable for the product of criminal enquiries.

5.7 The police have a statutory duty to carry out thorough and professional investigations into allegations of crime, and the obtaining of clear strong evidence is in the best interests of the child, since it makes it less likely that a child victim will have to give evidence in a criminal court. The police are the lead agency in respect of the criminal investigation.  

5.8 The police are also under a duty to record all suspected offences on a crime recording system.

Inter-Agency Notification of Child Protection Concerns between Police and Children’s Social Care

5.9 The following information relates to child protection concerns but children’s social care staff should be aware that some Section 17 cases may involve potential criminal offences against a child and that such cases should follow a similar process and be referred to child abuse investigation unit (CAIU) and a strategy discussion held as necessary. (Examples would include minor injuries and common assaults where there are no injuries. Whenever a concern is raised about such matters then this requires proper recording and decision making on the part of the police)

  • On being notified of a referral, children’s social care has a duty to decide within 24 hours whether an initial assessment is required and then, within 7 days, whether a core assessment is required
  • Where children’s social care have a case referred to them which constitutes, or may constitute, a criminal offence against a child, they should always discuss the case with the police at the earliest opportunity (but in any event before the end of that working day)
  • Where the police receive information which amounts to an allegation of a suspicion of child abuse, children’s social care must be advised as soon as possible (but in any event before the end of that working day)
  • During normal office hours, the police will notify the relevant children’s social care team
  • During normal office hours, children’s social care notify the CAIU referral desk
  • Outside normal office hours, the police will notify the children’s social care emergency duty team (EDT)
  • Outside normal office hours, children’s social care will notify the police force operations room who will make contact with the ‘on duty’ or ‘on call’ CAIU detective sergeant
  • On being so notified, both agencies agree to make immediate checks of their records (including whether the child is subject of a child protection plan) and intelligence systems for previous history and information that is relevant in deciding the level of enquiry that is required. The CAIU has the capability to access national databases of information such as VISOR (the Violent and Sexual Offenders Register) and the IMPACT nominal index (INI), which can check if there is information held by any other police force within the UK on any individual. Similarly children’s social care hold the child protection plans and case files that may contain detailed family background information that assess the risks of a situation
  • Where there is no suspicion of a criminal offence having occurred then there will not be a requirement for children’s social care to refer the matter to the police. However, staff may wish to consider the benefits of speaking with the police to request a check of police intelligence databases as this could help inform any assessment of risk. Examples of when there will not be a requirement to refer to the police:
  • Issues of neglect and poor parenting skills where there are no deliberate acts of cruelty, ill-treatment or abandonment (Unless concerns reach a level where a Section 47 enquiry is deemed necessary)
  • Minor injuries to children where the context of the injury and the information available, together with an assessment of the family history, suggests that an accidental explanation is more likely than a non-accidental explanation
  • Sexual behavior by a child with no disclosures of abuse and no concerning family history
  • If during the course of enquiries evidence of a possible criminal offence emerges the process may develop into a joint enquiry. Social workers will therefore need to be aware of the need to keep accurate and contemporaneous notes of any interview and be alert to the potential for medical and forensic evidence

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Strategy Discussions

Early Strategy Discussions

5.10 All Section 47 referrals, and any Section 17 referral that involves the suspicion of a criminal offence, will be subject of an early strategy discussion between the police and children’s social care. This discussion should normally involve a detective sergeant from the CAIU and a team manager from children’s social care. Following this discussion there should be a decision as to whether there is a need for:

  • No Further Child Protection Enquiries or Criminal Investigation

After initial enquiries and consultation between the police and children’s social care it may be agreed that further child protection action by either agency is not necessary as there is insufficient evidence of risk of significant harm to the child.  

  • Single Agency Enquiry

Where there is a need for a child protection investigation but there is agreement, following a strategy discussion, that the investigation will be commenced by a single agency with regular updates being shared with the other agency and continual assessment of the situation undertaken. The situations where a single agency enquiry is likely to be agreed are:

Children’s Social Care = Lead Agency:-

  • Suspected minor non-accidental injury on an older child and there are no significant concerns of previous abuse
  • Minor neglect or emotional abuse
  • Information concerning sexual abuse or behaviour, not amounting to an allegation but giving rise to child protection concerns
  • Abuse committed by a child who is under the age of criminal responsibility

Police = Lead Agency:-

  • Persons aged 18 years or over making historical allegations
  • Where the perpetrator is not a relative, carer or professionally involved with the child
  • Where the perpetrator is not known to the child

If during the course of the criminal investigation it emerges that parental deficiencies in the care of a child have significantly contributed to the alleged abuse the process will develop into a joint enquiry. Additionally, if risk to other children is identified in the course of a police single agency investigation then the need for a joint enquiry should be discussed with children’s social care.

  • Joint Enquiries

Joint enquiries will normally take place where initial information indicates that the situation falls into one of the following categories:

  • A clear allegation of familial sexual abuse
  • Alleged or suspected physical injury
  • Cruelty, ill treatment, or abandonment
  • Willful or repeated neglect
  • Concerns/suspicions of Fabricated or Induced Illness (FII)
  • Allegations against any employee of an LSCB agency or anyone who works with, or has contact with, children in either a professional or voluntary capacity
  • Organised, complex, or institutional abuse

Note – There will be occasions when one of the two agencies is unable to provide a timely resource for a joint investigation. There may have to be agreement that if there is a need for an urgent or speedy response then an initial assessment is undertaken by a single agency. This should, however, only occur when this has been agreed in a strategy discussion and documented.

Immediate Protection

5.11 Where there is a risk to the life of the child or a likelihood of serious immediate harm, the police officer or social worker must act quickly to secure the immediate safety of the child. Such emergency action may be necessary as soon as the referral is received, or at any point during involvement with children and families. The agency taking protective action must always consider whether this is also required to safeguard other children in the same household, in the household of an alleged perpetrator or elsewhere.

5.12 Immediate protection can be achieved by:

  • Removal of the alleged abuser
  • The alleged abuser agreeing to leave the home
  • Voluntary agreement for the child(ren) to move to a safe place
  • Application by children’s social care to court for an emergency protection order
  • Removal of the child(ren) under police powers
  • Gaining entry to the household under police powers (only covers certain circumstances where there is reason to believe that it is necessary to force entry in order to save life or limb or effect an arrest)

5.13 Legal advice will normally be sought by the social worker before initiating legal action to safeguard a child.

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Planning Joint Enquiries – Strategy Meetings and Discussions

5.14 Once the initial strategy discussion has concluded that there is a need for a joint investigation then a more detailed strategy discussion, or, if appropriate, strategy meeting will follow. If a strategy meeting is to be held it will be the responsibility of the CAIU detective sergeant and children’s social care team manager to discuss what urgent actions are necessary prior to that meeting in order to secure the safety of the child/children and/or better inform the meeting.

5.15 Enquiries will always be planned jointly. In urgent situations this will not prevent or delay an emergency response.  However, strategy discussions will remain a priority.

5.16 When a strategy meeting is required children’s social care will assume responsibility for convening, chairing and recording the meeting but should consult with the police and any other key agencies to obtain their availability.

5.17 Such a meeting should be held at a convenient location for the key attendees, such as a hospital, school, police station or children’s social care office.

5.18 Agencies will meet for strategy discussions if the enquiry is complex.  Strategy discussions on the telephone are appropriate when the referral is straightforward or to prevent delaying an emergency response. In these situations the discussion should be held between line managers or between staff who have line manager’s authority to do so.

5.19 In the following circumstances strategy meetings will always be held where Section 47 thresholds have been reached:

  • When the allegation is from a ‘looked after child’ concerning a member of staff/foster carer
  • Organised or institutional abuse
  • Fabricated or induced illness abuse
  • Allegations against staff and volunteers who work with children and young people
  • All joint enquiries that have added complexity (for example - allegations of abuse committed by a young person or child may fit this criteria)   
  • Female genital mutilation
  • Child abusive images on the Internet where the offender has ready access to children   
  • Children involved in prostitution
  • Children involved in human trafficking

5.20 Strategy meetings will be attended by both agencies, chaired by a children’s social care manager, or independent reviewing officer/independent chair. Other professionals will be invited when their expertise can contribute to the planning of the enquiries.

5.21 Both agencies will check their own records for all relevant information and intelligence prior to strategy meetings or discussions taking place. Other key professionals invited to the strategy meeting should also check any records that they have and supply any relevant information at the meeting.

5.22 Strategy discussions/meetings should identify:

  • The needs of the child protection enquiry
  • The needs of the criminal investigation
  • The needs of any internal discipline investigation

Please refer to chapter 13

and then plan how best to conduct an investigation which respects (most importantly) the needs of the child and also the needs of each agency.

Action Plan

5.23 Following discussions an action plan should be agreed and devised:

  • To plan the scope of enquiries
  • To agree responsibility for enquiries
  • To timetable tasks
  • To ensure that the conduct of enquiries best serves the interests of the child
  • To timetable the next strategy meeting / discussion

5.24 When planning the timings the following should be taken into consideration:

  • Conference deadlines of 15 days from the date of the last strategy meeting/discussion
  • Where a criminal offence may have been committed against a child, the timing and handling of interviews with victims, their families and witnesses, can have important implications for the collection and preservation of evidence
  • The viability of any possible forensic evidence
  • The potential for a child to be silenced, stories altered or evidence lost if action is not taken promptly
  • Any further risks to a child and any need for immediate protection
  • Suspects bail dates in a criminal investigation
  • Dates of any civil proceedings

5.25 Child protection enquiries must be sufficiently progressed to enable the initial child protection conference to reach an informed decision about the likelihood of continuing significant harm. It should be noted that the criminal investigation may continue beyond these timescales but the planning of timescales within the criminal investigation should take account of the need to progress the protection planning for the child(ren) whenever possible.

Record of Strategy Discussion /Meeting

5.26 At the conclusion of the strategy discussion both agencies will confirm their mutual understanding of what has been agreed and why and make a written record. This record should include the information shared, the decisions made and the basis for those decisions.

5.27 Prior to the conclusion of a strategy meeting the chair will be responsible for completing a pro-forma document which will record all the actions and timescales that have been agreed at the meeting. A copy of this document should be given to all attendees at the end of the meeting (and sent to those who gave their apologies before the end of that day). A full written record of the strategy meeting should then be produced and circulated to all participants (and those who sent their apologies) within seven working days.

5.28 Records should include the following:

  • Summary of information shared
  • Decisions taken
  • Reasons for decisions
  • Identification of roles and responsibilities
  • Whether a core assessment under Section 47 of the Children Act 1989 should be initiated
  • Whether a criminal investigation should be initiated
  • The need for any immediate protection and make clear whether by way of police protection or emergency Protection order
  • Time scales
  • Contingency plan
  • Who is to physically see the child, and ensuring that the child is seen without any potential perpetrator present
  • Who is going to act as supporter to the child in any video interview
  • Consideration of the need for an interpreter
  • Consideration of the nature and timing of medical assessment for the child or children
  • Identifying and seeing other children in the household
  • Consider whether the home should be viewed, including sleeping arrangements of the child
  • Identifying and seeing other children to whom the alleged abuser has access
  • Identifying persons responsible for abuse, planning who will speak with them and whether this will be an interview which may be used in any criminal proceedings (and therefore subject to rules of evidence)
  • Identifying witnesses / others who may hold information
  • Identifying any physical evidence that could help inform the investigation (records, diaries, computers, forensic evidence etc)
  • What information from the strategy discussion should be shared with the family

Further Strategy Meetings/Discussions

5.29 More than one discussion may be necessary, particularly where the circumstances are more complex. Essentially, each part of an investigation should have been discussed and agreed prior to any action being taken by either agency. Where a strategy meeting has been called then there should, unless all parties agree otherwise, be regular planned meetings to discuss the progress to date and plan for future actions.

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The Investigation

Parental/Carer Involvement

5.30 Parents/carers have a right to be informed of concerns and fully involved unless to do so would jeopardise the child's safety or that of other children, or undermine a criminal investigation.

5.31 Risk assessing is the key to knowing how safe or otherwise it is to involve parents/carers fully from the outset. At the outset of any child protection enquiry or criminal investigation it is vital that the decision on how to proceed is made jointly between agencies, and there should be no contact with any party prior to this taking place. The same initial process should be followed:

  • Share information with the other agency
  • Each agency to check all available databases for information regarding all family members
  • Strategy discussion to share the information collated
  • Risk assess the potential harm to the child / interference with evidence/if the parents/carers are involved from the outset. Also assess the risks that any party may pose to workers.
  • Decide on actions and timings of actions
  • Plan what may be shared with parents/carers and when to meet the needs of both agency’s investigations

5.32 In most situations, the route to safeguarding a child  will be through work with their parents/carers to develop a shared understanding of the concerns about their child's situation and the changes by the parent/carer which are needed to safeguard and promote his or her welfare.

5.33 In situations where there has been a gradual build up of concern about quality of care, the nature of concerns and reason for referral will have been discussed with the parents before referral.  This may have included involvement with the family by children’s social care prior to the situation reaching the threshold for child protection enquiries and criminal investigation.

5.34 Initial contacts with families also set the tone for future working relationships with them. The aim should be to be as open, direct and honest as possible about the nature of concerns, because this is likely to provide the best basis for a constructive working relationship and enables a thorough assessment of the protection needs. However the needs and safety of the child must remain paramount when determining what information is shared with parents/carers in these early stages, how this is done and when.

5.35 In a minority of cases, where there is serious harm or potential serious harm to the child, protection may depend upon steps to make the child safe before engaging parents/carers. Safety can also depend on the outcome of criminal or civil proceedings. These interventions can depend on withholding information from parents whilst evidence is collated. In some cases, such as where there are allegations of sexual abuse or more serious physical abuse, it will be appropriate to engage initially with the 'non-offending' parent/carer and there will be rare cases where even this is inappropriate (if for example they are likely to collude with the perpetrator or if the child does not wish them to be involved initially)

5.36 Exceptionally, for example, a joint enquiry/investigation team may need to speak to a suspected child victim without the knowledge of the parent or carer. The decision about when to inform the parent or caregiver will have a bearing both on the conduct of police investigations and on how the core assessment can be progressed effectively. The strategy discussion should decide on the most appropriate timing of parental participation.

5.37 Relevant circumstances when the decision not to inform the parent/carer include where:

  • A child would be threatened or otherwise coerced into silence
  • Important evidence would be destroyed
  • The child did not wish the parent to be involved at that stage and is

competent to take that decision  

5.38 There can also be a conflict of interests during the course of the enquiries between

  • The needs of the core assessment and child protection enquiries to  assess the whole family quickly (which may include speaking with the alleged perpetrator), in order to decide how best to work with the family, prevent harm through separation of a child from his/her family or gauge the family's reaction to the crisis

and

  • The needs of a criminal investigation to secure all other evidence before speaking with a suspect. Any alerting of the suspect prior to an interview (either directly or indirectly via a third party) makes it more difficult to check the truthfulness of their account and also gives them opportunities to dispose of evidence or arrange alibis.

5.39 When it is jointly decided to interview the child prior to the parents or carers being informed, the reasons for this must be recorded and the decision endorsed by a line manager.  The parent or carer will be informed as soon as practicable.  

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Seeing the Child

5.40 The child will not be interviewed in the presence of an alleged/suspected abuser.

5.41 Normally there will be a joint visit which involves a police officer and a social worker to speak with the child. They will need to decide on:

  • The timing and manner of any discussion with the child
  • Whether a visually recorded interview is appropriate
  • The practical arrangements and the support to be offered
  • Whether to interview other children within the family, or any other children the abuser has access to

5.42 Both agencies will provide an urgent response to the following referrals:

  • Severe neglect
  • Severe physical injury
  • An allegation of sexual or physical abuse and the child is frightened to go home

5.43 In all urgent cases the child WILL be seen within 24 hours

5.44 All children subject of joint child protection enquiries will be seen as soon as practicable and within 72 hours in order to assess the child’s safety and welfare.

5.45 Any agreement at a strategy meeting/discussion to operate outside of these timescales will be documented together with the reasons for the decision.

5.46 All other children in a household subject to a child protection enquiry will be seen by one or both of the agencies to enable an assessment of their safety to be made.

5.47 If children in other households are named, similar enquiries will be required.

5.48 Visually Recorded Interviews (Please refer to LSCB Practice Guidance ‘Achieving Best Evidence in Criminal Proceedings’)

In all cases where it is agreed to conduct a visually recorded interview of a child witness, then the advice contained within ‘Achieving Best Evidence in Criminal Proceedings: Guidance for Vulnerable and Intimidated Witnesses, Including Children’ (2001) will be followed.

5.49 The planning /assessment booklet will be completed for each and every child prior to any interview being conducted. (Police hold copies of these).  

5.50 Once agencies decide to conduct a visually recorded interview it will take place as soon as possible and normally within 48 hours of receipt of the disclosure. Where it is not conducted within 48 hours of receipt of the disclosure, both agencies will record the reason for the delay.

5.51 Both agencies will give consideration to involving specialists with the planning process or the investigative interview when they are dealing with children:

  • who have special needs
  • who have learning disabilities
  • who have psychiatric or psychological problems
  • who have speech or sensory impairment
  • where unusual or bizarre abuse is suspected
  • whose first language is not English

Interview with Alleged Perpetrator

5.52 The police will have responsibility for interviewing the alleged perpetrator in respect of criminal offences.  

5.53 The decision to arrest and interview an alleged perpetrator will be a tactical decision by the police but will take account of the need for children’s social care to engage with parents where this is in the best interest of the child.

5.54 Where the police have not progressed the investigation to a point where the interview of the suspect is appropriate but children’s social care need to discuss the concerns with the parents then a strategy discussion should take place between the officer in the case and the social worker to agree what information can be shared with the perpetrator.

Medical Assessments within Joint Child Protection Enquiries and Related Criminal Investigation

5.55 This procedure sets out the arrangements for child protection medical assessments, within child protection enquiries and related criminal investigations. It is not intended to replace the general duty on medical practitioners, nor to underestimate the value of involving them appropriately both as a source of information and as partners in providing services to safeguard a child and support a child and their family.

Purpose of the child protection medical assessment

5.56 The purpose of a child protection medical assessment is to inform decisions by the lead agencies about how best to safeguard the child. In order to do this, the medical assessment must:

  • Assess the child including all and any injuries
  • Establish if any medical treatment is required and action as appropriate
  • Establish if the physical evidence supports or negates any explanations given by the child or parent/carer
  • Ensure that any forensic evidence that may inform an investigation is recovered and injuries photographed where appropriate
  • Assess the levels of development, functioning and general condition of the child
  • Provide a verbal opinion and written report/statement on the assessment, in relation to the allegations and for any subsequent conference or court hearing
  • Provide advice regarding any further specialist assessment needed

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The Medical Assessment

5.57 Thresholds for medical assessments are based on the following:

Physical Abuse

5.58 Where non-accidental injury to a child is suspected this should normally trigger a child protection medical assessment. Even where injury appears minor, medical assessment is required both to ensure that there are no concealed injuries and to consider whether the explanations are compatible with the injuries found on the child. In the case of non-mobile babies, the potential significance of a very minor bruise should never be underestimated.

5.59 A child protection medical assessment may not be indicated where there are minor non-accidental injuries to an older child and the following factors are all present:

  • The explanation of how the injuries were caused given by both the parent and the child match each other and appear to fit the injury seen – i.e. this is an acknowledged instance of non-accidental injury
  • The child is mature enough to give a full account and does not appear in any way coerced
  • The police are in agreement (i.e. do not need medical opinion as evidence in criminal proceedings)

5.60 Where medical assessments are required for physical injury or serious neglect, the responsibility for arranging the medical will rest with children’s social care.

5.61 For neglect or suspected physical abuse where injuries appear to be minor, medical assessments are provided by a community paediatrician. In office hours contact is made via the safeguarding children office at Bridge Park Plaza. Where the medical examination of the child cannot then take place before 5pm the community paediatrician on call takes responsibility for arranging with the community paediatrician on the “out of hours” rota to complete the assessment. Where the need for a medical assessment is identified out of hours, ambulance control is contacted to access the community paediatrician on the out of hours rota.

5.62 Children who appear to have serious physical injuries or where the severity of neglect requires urgent treatment should be referred direct to a hospital. In Leicester and its environs this is Leicester Royal Infirmary. In parts of Leicestershire and Rutland bordering other counties this may involve referral to a hospital outside Leicestershire and Rutland.

Sexual Abuse

5.63 A child protection medical assessment is normally indicated where there is reason to suspect that the abuse has involved physical contact, or has been penetrative. The possibility of forensic evidence of abuse should be kept in mind. In some circumstances a medical assessment may be necessary to exclude a medical condition, the symptoms of which may have prompted initial concerns about sexual abuse.

5.64 A medical assessment (i.e. the physical examination of the child) may not be indicated where:

  • What is alleged does not involve direct contact with the child, e.g. exposure to pornographic images or material
  • Where the only indication of abuse is the child’s inappropriate behaviour
  • Where the allegation is historical and medical assessment would probably not provide corroborative evidence

Although the potential distress caused by intimate examination has to be considered in circumstances where the likelihood of physical evidence is low, it should be remembered that it is also possible for a physical examination to assist in reassuring a child that no permanent damage has been inflicted.

5.65 Medical examinations in sexual abuse enquiries fall to the police to arrange.

5.66 Two appropriately trained medical practitioners undertake medical assessment of possible sexual abuse, usually an experienced community paediatrician and a police forensic medical examiner.

5.67 Where the child suspected of being sexually abused appears not to have physical injuries requiring treatment, the arrangements for contacting the community paediatrician are as for minor physical abuse and neglect.

5.68 If the child has genital injuries requiring urgent medical treatment, this should be provided by the hospital and the assessment carried out by the medical practitioners as outlined above. Further treatment should be co-ordinated within the hospital setting.

Neglect

5.69 Medical assessment within child protection enquiries is most likely to be indicated where there is:

  • Need for treatment, e.g. anaemia; serious under-nourishment, dehydration
  • Signs of visible physical damage; e.g. severe nappy rash; damage from chronically ill fitting shoes; scabbing from head lice; untended wounds or abscesses; chronic dental problems
  • A possibility of other forms of abuse
  • Need for objective assessment records – e.g. measurement of the height, weight etc.
  • A child protection medical assessment during the enquiry stage which could assist in benchmarking the child’s condition when this is being severely compromised by neglect

5.70 There will usually be a need for subsequent medical, developmental assessment and monitoring as part of the child protection or child in need plan.

5.71 The process for arranging and conducting a medical examination in a neglect case is as outlined above for physical abuse.

Emotional abuse

5.72 Where emotional abuse appears to be the sole form of abuse an immediate medical assessment is not likely to be indicated. However, subsequent planned assessment by the child and adolescent mental heath service (CAMHS) can be appropriate to confirm whether relationships in the family are significantly abusive, to verify the impact on the child and to consider the child’s therapeutic needs.  Referral to this service should normally be in consultation with the family’s general practitioner.

General Considerations

5.73 whenever a child protection medical assessment is sought for a particular child, consideration must be given as to whether the siblings/other children in the same household should also be medically assessed. The onus should be to justify why medical assessment of the other children is not appropriatewhen a medical assessment is requested under the procedures, both social workers and doctors should ensure that the doctor is aware of all relevant history, particularly where this involves injuries of a similar nature to those being examinedrepeated examinations of children should be avoided, particularly in cases of sexual abuse. The gender of the doctor may be important, effort should be made to accommodate a preferencein undertaking an assessment where one form of abuse is suspected, the medical practitioner should be mindful that the child may have sustained other forms of abuse or have health needs which have not been met. Consultation with an appropriate mental health medical practitioner may be necessary, when there are serious concerns about the child or young person’s mental healthwhere the outcome of a medical assessment contradicts other information known to professionals then staff should have the confidence to challenge the medical opinion. In some circumstances the police or children’s social care may wish to seek a second opinion for clarification. The original examining doctor should be advised of the proposed action and the reasons for doing so. The reason for this request should be clearly recordedoccasionally, a parent may be advised by a social worker to take their child to their general practitioner for treatment of a minor injury. This should never be used as an alternative to a child protection medical assessment

Responsibilities of the Social Worker

5.74 Whenever a child protection medical assessment is sought, the request to the medical practitioner by the social worker must always clearly identify:

  • The reasons why a child protection medical assessment is required (see section on ‘guidance on thresholds’)
  • The purpose of the medical assessment, and the expectations placed on the medical practitioner
  • The degree of urgency for the assessment (Please refer to Section on ‘timing’)
  • Any consent issues to be resolved (Please refer to section on ‘consent’)
  • Ensuring medical practitioner has all relevant information of known previous medical assessments undertaken at the request of children’s social care

5.75 The social worker should always accompany the child and adult family member, in order to assist with any supplementary information, including any previous relevant family history, e.g. history of previous injuries of child or siblings and to ensure that there is opportunity for private consultation with the medical practitioner regarding outcomes.

5.76 Where the child is taken direct to the hospital, the social worker must ensure that the paediatrician is contacted speedily, and fully informed of the concerns and nature of the injuries. The social worker should ensure that any explanations given in their presence by the child or other family members to the medical practitioner are recorded.

5.77 As part of child protection enquiries, the social worker will normally contact the family practitioner to obtain any relevant information known about the family which assists in assessing the situation holistically.  The GP should be notified of the outcome of the enquiries.

5.78 Exceptionally a minor non-accidental injury to an older child may need checking out medically but the police and children’s social care may already be satisfied that future risk is minimal. The child can be seen by their general practitioner in these circumstances. The social worker need not accompany the child but should brief the general practitioner to avoid confusion about the nature of what is being sought.

Responsibilities of the Police Officer

5.79 Where the medical assessment relates to suspected sexual abuse it is the responsibility of the police to liaise with the on-duty forensic medical examiner and arrange for an examination to take place. An appropriately trained police officer will be present at that examination in order to brief the forensic medical examiner and paediatrician regarding the circumstances of the case, and to package and label all exhibits recovered.

5.80 Where the medical assessment relates to suspected physical abuse, and there is any likelihood of any forensic evidence being recovered (i.e. body swab of a bite mark), a police officer should be present to take ownership of the exhibits. Where there is no likelihood of forensic evidence being recovered, then there is no expectation on the police to attend the medical assessment. They should, however, have the opportunity to brief the medical practitioner prior to the examination regarding any relevant facts regarding the police investigation.

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Responsibilities of the Medical Practitioner Providing the Assessment

5.81 Medical practitioners should ensure that they:

  • Are fully aware of the reasons for the assessment being requested and ensure they have all relevant information known to children’s social care
  • Address both the presenting concern and on going health needs
  • Record their findings and in particular any explanations for injuries given by the child or any accompanying adult and where findings are inconclusive this should be explicitly recorded
  • Be conversant with the use of the colposcope and use it to record evidence where appropriate, for assessment in cases of suspected child sexual abuse
  • Provide a verbal report to the social worker / police officer as soon as possible after the child has been seen stating a clear opinion about their findings in relation to the concerns. The social worker and police will use this in making decisions about immediate protection and criminal investigations
  • Provide a written report within 5 working days, which should confirm the verbal report already given
  • Provide a statement to the police if requested within 14 working days
  • Be prepared to provide further opinion on whether any subsequent explanation for injuries is compatible with what was seen

5.82 In exceptional circumstances the medical practitioner may wish to seek a second opinion. The social worker and/or police officer should be advised of this and the reasons for doing so. The reasons should be clearly recorded.

5.83 Where a child attends hospital, the procedures to ensure that safe discharge arrangements are in place must be followed.  Please refer to Chapter 19.

Timing of the Medical Assessment.

5.84 Medical assessments within child protection enquiries can be pivotal in assisting the children’s social care or the police to make informed decisions on whether it is both appropriate and legally possible to take immediate steps to protect a child and/or their siblings. The degree of urgency for medical assessment will depend not only on the severity of the immediate harm requiring urgent medical treatment but also on whether:

  • There are issues relating to the immediate care of the child
  • There is a need to record the physical evidence of abuse before it  disappears
  • There is a possibility of forensic evidence being available
  • Seemingly minor injury may conceal more serious physical harm (particularly in babies)
  • There are other children (of the family or elsewhere) who may need safeguarding as a consequence of the medical assessment

5.85 A child with minor physical injuries, particularly non-mobile babies, should normally be medically assessed the same day or within 24 hours.

5.86 A child who is thought to have been recently sexually abused, should be seen quickly enough to preserve possible forensic evidence or document physical evidence of abuse.   Where the referral relates to penetrative sexual abuse that has occurred in last 7 days, immediate medical assessment should be sought.

5.87 A child who appears to be suffering from chronic neglect not requiring urgent treatment, or sexual abuse where no recent episode is suspected, need not be seen the same day. However, it should be noted that signs of neglect may change quickly if care of the child is improved and timely medical assessment can be important to benchmark or ensure treatment is started. Please refer to section on thresholds for medical assessment

Involvement and Consent of Parents/Carers and Children

5.88 Those conducting child protection enquiries must always secure consent for the child to be medically examined, treated or photographed. In the majority of cases, this consent will be given by parents/carers.  Occasionally it will be necessary to gain consent by court order. Any relevant documentation should be shown to the examining doctor.

5.89 A parent’s refusal for a medical assessment should not be allowed to cause unnecessary delay. Legal advice should be sought urgently.

5.90 Young people aged 16 years and over are able to give their own consent to be medically examined, treated or photographed. However it is good practice to involve parents unless to do so would jeopardise the child’s welfare or is against their wishes.

5.91 Some children under 16 years may be assessed by the medical practitioner to be Fraser competent to give informed consent. Legal advice should nevertheless be sought if this is against the parent’s wishes.

5.92 Children must not be medically examined against their wishes unless the medical practitioner believes that there is a need for emergency medical treatment.

Hospital Discharge for Children About Whom there are Child Protection Concerns

5.93 Accident and Emergency departments are likely to be the first point of contact for children suffering significant injuries whatever the cause. It is therefore particularly important that all staff working in and with hospitals recognise abuse and neglect as a possible cause of injury and are aware of their responsibilities when this is a possible diagnosis.

Child protection concerns may arise within hospitals through a number of routes:

  • On referral/admission an agency may have expressed concern about the origin of an injury or medical condition
  • There is no immediate concern, but a child admitted to hospital has a child protection plan
  • A child presents at the hospital with injuries or a history which hospital staff consider raises concerns
  • Whilst the child is in hospital staff observe behaviour or family inter-action which gives rise to concern
  • While being examined, or once admitted, a child discloses information which suggests that they have, or may have been, abused

5.94 When assessing injury or illness clinicians should always consider abuse or neglect among possible causes.  Key issues for hospital staff to bear in mind are:

  • The need to ensure that decisions about what to discuss with parents/carers, how and when are agreed with the investigating agencies (police and children’s social care)
  • That the child should be fully involved, having regard to their age and understanding
  • That delay should be kept to a minimum, such that, for example, the results of tests and other information are made available as a matter of priority to assist the assessment of the child’s safety and discharge planning

5.95 For any child visiting or admitted to hospital about whom there are concerns, a checklist form will be completed. This identifies those responsible and ensures that key actions are taken, including the completion of a safe discharge plan, and ensuring that key workers in the community receive relevant information.

5.96 A senior doctor (not below Specialist Registrar) should always be identified to oversee the liaison with other agencies and manage the discharge of such a child.

5.97 The child should not leave the hospital without children’s social care and the police child abuse investigation unit being notified and, where necessary, a management plan devised.

5.98 Given the research evidence and local experience, any injury to a pre-mobile child should raise concerns and an inter-agency meeting should be held before discharge is agreed. In exceptional circumstances it will be agreed that the cause and context of the injury is clear and that a meeting is not required.

5.99 A written medical opinion should be made available within 5 working days, irrespective of the plans for the child. If requested by the police, a statement and relevant information should be made available within 14 working days.

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Steps to be taken at the Conclusion of Child Protection Enquiries

Completion of a Child Protection Enquiry

5.100 The social worker has the responsibility to draw together and analyse the findings of the child protection enquiry, in consultation with the police officer, involved professionals and agencies, and the child and parents/carers.

5.101 The child protection enquiry is concluded at the point when an informed decision is made taking account of all information available as to whether the child is at continuing risk of significant harm or not.

5.102 The three possible outcomes of a child protection enquiry are:

  • Concerns are not substantiated
  • Concerns are substantiated but the child is judged not to be at continuing risk of significant harm
  • Concerns are substantiated and the child is judged to be at continuing risk of significant harm

5.103 The related criminal investigation may be ongoing at this point.

Completion of Criminal Investigation

5.104 Decisions regarding the outcome of a criminal investigation will be made either by the supervisor of the investigating officer or, in more serious or complex cases, by a lawyer from the crown prosecution service. Where an ‘advice file’ has to be submitted to the crown prosecution service this can result in significant delays before an outcome is known.

5.105 The possible outcomes from a criminal investigation are:

  • Insufficient evidence with which to proceed
  • Sufficient evidence to proceed but not in the public interest to do so
  • Complaint withdrawn (this does not automatically halt a prosecution but it can be difficult to proceed without a willing complainant)
  • Police caution administered (this counts as a criminal conviction but can only occur where there is an admission of guilt)
  • Criminal prosecution through court by charging the suspect with offences. (Suspect will only have a criminal record if there is finding of guilt by the court)

Where Child Protection Concerns are Not Substantiated

5.106 Enquiries may not substantiate the original concerns about the child being at risk of, or suffering, significant harm. No further action may be necessary, apart from ensuring that written feedback is provided to those involved. Alternatively, the enquiries may have revealed that the child is a “child in need of support” as defined by section 17 of the Children Act 1989.

5.107 In these circumstances the social worker should conclude the core assessment and consider with the family:

  • The nature of any ongoing concern about significant harm (albeit not fully substantiated by evidence)
  • Whether there is a need for support and/or services
  • Whether there is a need for enhanced monitoring through the involvement of other agencies

5.108 If these are agreed, the following must be clarified with the agencies who will undertake this monitoring:

  • What needs to be monitored and why
  • How this is to be achieved and by whom
  • Who will review the monitoring and how
  • What should trigger re-referral to children’s social care

Where Child Protection Concerns are Substantiated

5.109 Where the concerns are substantiated by the enquiry the social worker must also consider whether there is continuing risk of significant harm. In most cases, an initial child protection conference will be convened to assess all the relevant information and plan how to safeguard the child and promote his or her welfare.

5.110 In some instances, there may be good reason to conclude that, despite the fact that a child has been significantly harmed, no continuing risk of significant harm now exists and an initial child protection conference is not needed. The following are examples of where this may occur:

  • Family circumstances have already substantially changed (e.g. the perpetrator of abuse may have permanently left the household and may no longer have contact with the child or the child may have permanently left the household)
  • The significant harm is judged to have been the result of an isolated abusive incident (e.g. abuse by a stranger)
  • The parent, carer, or members of the child’s wider family are judged to be willing and able to co-operate with actions to ensure the child’s future safety and well-being without the need for a child protection plan

5.111 The decision to use discretion not to convene an initial child protection conference where a child has been judged to have been significantly harmed will only be acceptable if there is:

  • An evidence-based assessment  
  • Evidence that any child who is of sufficient age and understanding has explicitly expressed the view that he/she now feels safe
  • Agreement between the agencies most involved to the proposed way forward
  • Endorsement of the decision at team manager level within children’s social care
  • Agreement about any continuing services or monitoring to support the child and/or family
  • Agreement about what would trigger either re-referral to children’s social care or reconsideration of the likelihood of continuing significant harm if a child in need service plan is agreed with the family

Feedback about the Outcome of the Enquiries

5.112 The outcome of enquiries must be recorded by the social worker, with the assessment and reasons for the decision clearly stated. Parents/carers and professionals/agencies who have been significantly involved should receive a copy of the record unless providing the information would expose a child to continued risk of harm or breaches any third party confidentiality. Where the outcome is the convening of an initial child protection conference, the social worker’s report to conference stands as the record of the outcome of the enquiries.

Feedback on the Outcome of Related Criminal Investigations

5.113 Where there has been a joint child protection enquiry the police officer should always feedback the outcome of the criminal investigation, including any additional evidence found after the completion of the children’s social care assessments.

Problem Resolution

5.114 Both agencies agree that where practitioners encounter disagreements in joint investigations the appropriate form of resolution will be for the practitioners to highlight the disagreements to their immediate line managers. The line manager will then assume responsibility for resolution by contacting their counterpart in the other agency.

If the decision not to proceed to conference is disputed

5.115 Those agencies and professionals who are most involved with the child and family and those who have taken part in enquiries should dispute the analysis, and seek further discussion with the social worker and his/her manager, if they remain seriously concerned about the safety of a child.   

5.116 Any agency may then request that children’s social care convene a child protection conference. Any such request will normally be agreed, if it is supported by a senior manager from the agency concerned, or by a named or designated professional.

Child Protection Enquiries in Particular Situations

5.117 Child protection enquiries and related criminal investigations which need additional consideration are dealt with in separate chapters.  They should be read in conjunction with this chapter wherever abuse is suspected and information is contained in the following chapters:

Please refer to:

Chapter 9-    Abuse by Children and Young People

Chapter 11-    Children and Young People Abused by Prostitution

Chapter 13-    Allegations Against a person who works with, or is in contact with, children in a work or care setting, including volunteers.

Chapter 14-    Fabricated or Induced Illness (FII)

Chapter 15-   Investigating Complex (Organised or Multiple) Abuse

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