Document Review

Revision History

[1] Australian Institute of Health and Welfare (AIHW). Child protection Australia 2021–22 web report (catalogue number CWS 92). 2024 [accessed 19 September 2024] www.aihw.gov.au/getmedia/2cecbc62-8c65-4031-a6df-5fec9422b0cf/child-protection-australia-2021-22.pdf?v=20240516104741&inline=true

[2] Oranga Tamariki, ministry for Children. Disparities and disproportionality experience by tamariki Māori. [published 23 August 2023]. https://www.orangatamariki.govt.nz/about-us/research/our-research/report-on-disparities-and-disproportionality-experienced-by-tamariki-maori/

[3] Assembly UG. Convention on the Rights of the Child. United Nations, Treaty Series. 1989 Nov 20;1577(3):1-23.

[4] United Nations. World Program of Action for Youth. 1995. Division for Inclusive Social Development

4.1 ED clinicians should always consider the possibility of child abuse and neglect when evaluating paediatric patients, and children accompanying adult patients, especially those who present with injury, failure to thrive or behavioural problems. They should also be aware that children at risk may present with a wide range of complaints and can be subject to more than one type of maltreatment.

4.2 Failure to consider the possibility of abuse and neglect when appropriate may result in a child being returned to an abusive or unsafe environment. Vulnerable children and young persons should not be discharged from the ED until their safety can be ensured. However, clinicians should be mindful that chronic risk does not always signal an immediate risk of harm.

4.2.1 The medical evaluation of children who are suspected of having been abused should be performed by clinicians skilled in both paediatrics or paediatric emergency medicine and child abuse evaluation.

4.2.2 Health care cannot be clinically safe, unless it is also culturally safe. Health services should provide staff with explicit and rigorous training in anti-racism and provide systems to support clinicians to provide culturally safe care.

4.3 ED clinicians should have completed appropriate training on child protection, family violence and cultural safety and possess the skills necessary to identify, report and manage concerns appropriately.

5.1 Hospital responsibilities

Hospitals will:

5.1.1 Advocate for and participate in interdisciplinary approaches to child protection that include protocols and policies for identification, assessment, reporting, trauma-informed care and intervention. In doing so, hospitals will recognise that child abuse and neglect is a complex problem, and more than one type of treatment or service may be needed to support children and their whānau, family and carers.

5.1.2 Ensure that staff are educated in the detection and evaluation of children at risk of abuse or neglect, and that staff are aware of the legal requirements and whether mandatory reporting is required in their jurisdiction, including what constitutes ‘reasonable grounds’ for reporting a concern. A referral and notification system must exist, that is compliant with legal/regional guidelines, and staff must be mandated to refer actual or suspected abuse or neglect via this system.

5.1.3 Set and maintain documentation standards for clinicians recording and documenting concerns, and allow clinicians protected time and adequate resources to undertake this important clinical work

5.1.4 Provide staff with appropriate access to advice on difficult situations involving consent, confidentiality and sharing of medical information, to cover ethical and legal matters appropriate to the ED environment and jurisdictional laws.

5.1.5 Ensure quality improvement processes are in place to identify opportunities for learning and improvement.

5.2 ED responsibilities

EDs will:

5.2.1 Provide frequent in-house collaborative training for all clinicians to increase the capacity to identify, report and manage children at risk of abuse, neglect or family and domestic violence.

5.2.2 Provide appropriate care for victims of abuse or neglect based on legislation, local protocols and referral patterns, and provide appropriate educational resources.

5.2.3 Implement systems that facilitate appropriate documentation and reporting of all suspected cases of child abuse or neglect, including systems that identify children attending frequently and those with known child at risk status.

5.2.4 Increase vigilance by encouraging all clinicians to actively look for and be open to the possibility that a paediatric patient or the child of an adult patient may be at the risk of abuse, neglect or family and domestic violence and by actively educating staff to be aware of the variable presentations that indicate a child of abuse or neglect.

5.2.5 Encourage and actively seek frequent interdisciplinary communication with local child protection authorities, other EDs and interested groups, to create a multilevel information exchange around process, feedback, outcomes and advice.

5.2.6 Ensure patients and their whānau, family and/or carers are treated in a culturally appropriate and sensitive manner, seeking support from First Nations Health Officer /Aboriginal Hospital Liaison Officers / Māori Liaison Officers where possible. If language barriers exist; an interpreter must be used. Care should be taken if the interpreter is from the same community as the child, to safeguard against privacy concerns.

5.3 Clinicians

Emergency medicine clinicians will:

5.3.1 Be vigilant in considering the possibility of child abuse, neglect or family and domestic violence.

5.3.2 Maintain professional education and knowledge of local processes and procedures to support child protection.

5.3.3 Ensure documentation includes appropriate language and be aware that clinical notes may form part of future legal processes.

5.3.4 Provide trauma informed care and avoid negative stereotyping and consider the cultural and spiritual needs of children, young people and their families.