Cases and information sharing

1. Cases and information sharing Clare Robertson

2. Case 1 • Mrs X is a patient at your practice. She has 2 young children. In the course of the consultation she mentions that she is in a happy new relationship with Mr Y. You are aware that he has a previous conviction for child sexual abuse.

3. Issues and what to do • clarify whether Mr Y is the person you are thinking of, • It is not your role to share with the woman – but this should be discussed with a Named Nurse to clarify. • Named Nurse will help clarify his offence (and bail conditions or probation restrictions MAPPA) with the police and what his risk maybe/may not pose risk to children. • Police/Social Services can share information with the woman if appropriate, so that steps can be taken to protect her children • Social Services can conduct an investigation depending on the mother’s response e.g. is she in denial of the offence? Probably not necessary if mother terminates the relationship and has no further contact with him. • Sex offenders are good at grooming vulnerable families

4. Case 2 During a consultation a 12 year old girl requests emergency hormonal contraception. She asks you to keep this information confidential.

5. Issues Sexual Offences Act – Sexual intercourse under 13 years old is a criminal offence and is classified as rape. should provide emergency contraception if required Child Protection advice from Named Nurse/Designated Doctor/Social Care if under age 13 – most cases will need to be referred to Social Care/police – but if child was consenting and boy same age –probably no criminal prosecution Refer to sexually active under 18’s OSCB guidance and flow chart. It must be made clear to young person that absolute confidentiality cannot be guaranteed. Encourage young person to share information with their parents/carers wherever safe to do so. If not safe, then encourage young person to identify a trusted adult who can support them.

6. Issues Factors to be considered - power imbalances, overt aggression, coercion, bribery, misuse of substances as a dis-inhibitor, whether attempts have been made to secure secrecy, grooming, sexual partner is known by one of the agencies, whether a child denies/minimises or accepts concerns, whether child’s own behaviour is influenced by misuse of substances. Referral to comm. paeds for CSA examination if boy/man older and/or no consent– if episode <72 hours ago urgent medical and forensic swabs, plus screening for STDs. Ring and ask for advice.

7. Case 3 Social and Health Care telephone you asking if you have any concerns about a family.

8. Issues Check it is Social Services – phone them back Clarify what they want to know Think before you speak and say you will provide a written report Ask HV about the family It is your duty to share this information – the child’s welfare is paramount Information given should be relevant and proportionate

9. Case 4 You are preparing to attend a Child Protection Case Conference. You notice from the mother’s medical records that she has a past history of depression and substance misuse. You have no current concern about either.

10. Issues Ask Social Services if mother knows that you are attending There should be no surprises at the conference Share a report in advance if able to Let Conference Chair know so this can be handled at conference, if any difficult information needs to be shared. Inform mother you will be sharing relevant information State what level of contact with the mother and child you have had, as no current concerns need to be evident in relation to your level of contact Historical information is relevant to inform risk assessment Attend Case Conference - if possible

11. Case 5 • A mother discloses that she is a victim of domestic abuse. She says that the children are ‘fine’

12. Issues and what to do • Usually there are many incidents of DA before victim seeks help • Ask more about it • Try and ascertain how safe children are and whether woman is able to protect them • Check GP records for her, her partner and children for evidence of injuries or other problems • Link with HV • Assess risk ( Increased with pregnancy, mental health problems and substance misuse) DASH form • Offer support – helpline contact no • Be aware of the risk of escalation

13. Case 6 • Mother of 7 week old baby attends to discuss problem of sore nipples. She is new to the area and you don’t know the family. You notice a bruise on the child’s cheek. You ask mother what has caused it and she says she doesn’t know

14. Issues Bruise on non-mobile child NAI high possibility vague history is worrying

15. What should be done? Full examination of baby ( including hidden sites – frenulum, behind ears) Check whether child has Child Protection plan or any other flags such as for domestic abuse, and also check parents’ notes If possible get more information from health visitor Refer to paediatric team at the JR, ? inform SS

16. Difficult questions ‘He has a bruise on his face – do you know how it happened?’ ‘It is very unusual for a baby that is not moving to have a bruise like this. I am concerned about it and I need to refer to the paediatrician for a further assessment/ opinion’. Warn will need further tests. If the parent asks for more information, then ‘with bruising in a little baby, one of the things we have to consider is whether someone has intentionally harmed/hurt the baby’. ? how much openness – if they don’t ask ? ‘Social services will need to be made aware of my concerns’– or wait for hospital to do

17. Case 7 • Member of staff has worked for you for 5 years, has recently moved to a role requiring a CRB check. Check comes back indicating a positive disclosure about a child pro investigation some years ago – but outcome is not noted

18. Issues • Must be followed up • Practice manager and GP must risk assess as to whether staff member can continue to work with supervision, or to stop work whilst enquiries are made • Discuss with designated nurse at PCT • Advice from PCT HR • Further information available form Criminal Justice Board

19. Case 8 • You receive info that a young couple is often fighting late into the night. Apparently there is a lot of shouting and woman has been heard crying. They have a young baby and 5y old

20. Issues • ?DA – young children in house • Consider same factors as above case • Encourage informant to contact SS themselves • Check GP records • HV to review family – see mother on own • Offer help and advice, helpline • Assess risk – refer SS if concerns

21. Learning points • GP central record holder • Often has information on all of the family • Sharing info is vital. Attend case conferences • Child’s welfare is paramount, and over-rides issues of confidentiality for parents • BRUISING in NON-MOBILE BABIES • Risk factors – DV, mental health problems and substance misuse • Parents in child protection cases are often challenging and devious • Professional challenge and persistence sometimes needed