Islington Community Paediatrics: Pathway for Children Referred with Child Protection Concerns

Email for referrals: cpadmin.islington@nhs.net

Who is this care pathway for?

This care pathway has been written primarily for families and carers of a child who has an emerging or identified concern regarding child protection.

This information in this page is also likely to be of interest and helpful for professionals as well.

Who do we see?

We see children and young people up to 18 years of age where there are concerns about possible abuse or neglect, who have an Islington GP or attend a school in Islington.

How to use this tool

When you scroll down you will see the information provided in this care pathway is set out in the following sections:

Who we see?
Who can refer and how?
Care Pathway: gives a flow-diagram type overview of the pathway
Detailed actions: sets out in more detail what is involved in the different parts of pathway
Associated documents: more for use by professionals
Resources: these are links to relevant web sites
Quality standards: this is a list of the quality standards that we report on annually on this web site and these are designated by QS where they appear in the text

Who can refer and how?

This will depend on what the concerns are:

Usually it is your social worker who will refer your child to this service e
For children where the concerns are not of an acute nature, such as neglect and emotional abuse, referrals can be made by any professionals including your SW, but also your GP, school nurse or health visitor
Where the concern is about acute sexual abuse, your child will be referred to one of the London Havens (see resource section below for link), but if the alleged sexual abuse is non-acute then we can see you child locally

Just to note that we do not accept referrals directly from families, but for all referrals we receive it must be clear that someone with parental responsibility has given consent for the medical to go ahead, or that the young person is able to consent themselves (see NSPCC - A child's legal rights: Gillick competency and Fraser guidelines).

If anyone has concerns that a child or young person is being abuse then you can contact Children�s Social Care in Islington by phoning:
020 7527 7400 during office hours
OR
020 7226 0992 out of hours
There is further information at Islington Services for Helping Families and Safeguarding Children.

For professionals making a referral:

For acute referrals the professional can phone 020 3316 1885
For non-acute referrals they can phone the same number, or email cpadmin.islington@nhs.net
If the professional is uncertain or wants advice they can also call the above number

Care Pathway

Detailed Actions to be Completed

Referral Received	When your child is being referred to this service this should be discussed with you so that you are aware of the reasons for the referral and your consent given. There are times when a court may make an order asking us to see your child or the local authority may obtain a court order that allows social care to give consent for the medical on your behalf. Please note: We use an electronic patient record to hold our clinical notes and documents. This in turn is accessible by other professionals who work for Whittington Health and helps greatly with our information sharing At the end of each appointment we will write a report that is sent to you with an agreed plan and copy list of all relevant professionals. We aim to send this out within 2 weeks of the appointment (QS-1) We welcome, actively seek and act on feedback from all who use our services (QS-2)
Referral Triaged	A paediatrician will review the referral of your child and take a decision based on the information provided as to the best clinic for them to be seen in (further details on the different clinics are given below): Daily referrals clinic: this is for children where there is an allegation of an acute injury; in this clinic we aim to see your child on the same day as the referral, or the following working day if this is not possible Weekly clinic: we see children where there are no concerns about an acute injury; in this clinic we aim to see the child within 1 month Non-acute child sexual abuse: we aim to see children and young people within 2 weeks
Daily Referrals Clinic	If your child is seen in this clinic the paediatrician will undertake a holistic assessment that will focus on any alleged incident as well as the medical, developmental, social and family history for your child. You and your child will usually be seen with your social worker in the clinic, and when involved, a police officer Your consent is a prerequisite for this to go ahead, but if your child is judged Gillick competent then they can give consent themselves (see resources list below) We will examine your child and will record the examination findings on body maps (these are outline drawings of a child�s body); we also have the option of getting medical photography if needed At the end of the assessment we give the social worker a hand written summary and recommendations which is followed up with a formal typed report Any investigations undertaken from the assessment will be fed back to you either by letter or at another appointment If your child is followed up then they will be seen in our Weekly clinic We have a monthly peer supervision meeting in the department where cases are discussed as part of quality control and for learning If Children�s Social Care arrange a Child Protection Conference we always aim to attend this depending on other clinical commitments
Weekly clinic	If your child is seen in this clinic it is because either: We received a referrals where there was no acute injury, typically where neglect or historical abuse is the concern, OR They were seen in the daily clinic where follow up was agreed as part of the plan The assessments undertaken and our way of working in this clinic is otherwise the same as that described above in the Daily referrals clinic
Non-acute child sexual abuse	If your child is seen in this clinic it would be because: We received a referrals where there was an allegation of non-acute sexual abuse, OR They were referred to us for follow up having been seen following an acute sexual assault in one of the HAVENs (see web links below) As in our other clinics consent is a requirement. The assessments undertaken are holistic, and in doing this work we work closely with colleagues in social care and the police . This clinic takes place at the St Ann�s Hospital site in Haringey where we work closely with colleagues in Sexual Health which is located on the same site at St Ann�s. Acute sexual abuse: the definition of acute sexual abuse is based on age, gender and when the alleged incident took place: Girls 13 years of age and over, where the alleged incident took place within the last 7 days Girls under 13 years of age and boys of all ages, where the alleged incident took place within the last 3 days Non-acute sexual abuse: Sexual abuse that falls outside of the above definition is non-acute sexual abuse
Discharge	When our work is complete then we will discharge your child from follow up while ensuring that colleagues in universal health services (e.g. GP, health visitor and school nurse) are informed of your child�s needs. Professionals are always able to refer back to us if you or they had any further concerns about your child.

Associated Documents

Resources Table

Useful links
Islington Children's Services Assessment Team	There is further information on the local authority web page for child protection.
Working Together to Safeguarding Children	A guide to inter-agency working to safeguard and promote the welfare of children (March 2015).
London Child Protection Procedures and Practice Guidance	These procedures and practice guidance contains sections on core procedures, practice guidance, threshold documents, and amendments and archives.
Islington Safeguarding Children Board (SCB)	Islington SCB is a statutory body that helps all Islington organisations who have contact with children, young people and their families to work together effectively in order to safeguard and promote the welfare of children and young people.
NICE clinical guideline: When to suspect child maltreatment	This NICE guideline covers the alerting features in children and young people (under 18 years) for physical, sexual and emotional abuse; neglect; fabricated or induced illness.
NSPCC	The NSPCC or National association for the prevention of cruelty to children is a leading UK charity fighting to end child abuse in the UK. They offer help children who�ve been abused to rebuild their lives, protect those at risk, and find the best ways of preventing abuse from ever happening.
NSPCC - A child's legal rights: Gillick competency and Fraser guidelines	The Gillick competency and Fraser guidelines help us all to balance children�s rights and wishes with our responsibility to keep children safe from harm.
The Havens	The Havens are specialist centres in London for people (children and adults) who have been raped or sexually assaulted.

Quality Standards Table

QS-1	We will send out our clinic letters within 2 weeks of the appointment
QS-2	We welcome, actively seek and act on feedback from all who use our services