POLICY CHILD/YOUNG PERSON ABUSE AND /OR NEGLECT CHILD IN NEED POLICY & PROCEDURE

Transcription

1 POLICY CHILD/YOUNG PERSON ABUSE AND /OR NEGLECT CHILD IN NEED POLICY & PROCEDURE Applicable to: MidCentral Staff Issued by: Clinical Board Contact: Family Violence Intervention Coordinator CONTENTS PAGE 1. PURPOSE PRINCIPLES SCOPE TERMS AND DEFINITIONS ROLES AND RESPONSIBILITIES... 2 EXECUTIVE RESPONSIBILITIES... 2 TRAINING... 3 SERVICE RESPONSIBILITIES... 3 STAFF SUPPORT, SAFETY AND SUPERVISION... 3 EMPLOYEE RESPONSIBILITIES... 3 HUMAN RESOURCE RESPONSIBILITIES... 4 FAMILY VIOLENCE INTERVENTION CO-ORDINATOR RESPONSIBILITIES... 4 MIDCENTRAL DHB EMPLOYEES AND FAMILY VIOLENCE... 4 MAORI AND THE FAMILY VIOLENCE INTERVENTION PROGRAMME... 4 PACIFIC PEOPLE S AND THE FAMILY VIOLENCE INTERVENTION PROGRAMME PROCEDURES FOR RESPONDING TO ACTUAL/SUSPECTED ABUSE/NEGLECT IDENTIFY (STEP 1) SUPPORT AND EMPOWER VICTIMS OF CHILD ABUSE/NEGLECT (STEP 2) ASSESS RISK (STEP 3) SAFETY PLANNING/INTERVENTION (STEP 4) DOCUMENTATION (STEP 5) REFERRAL (STEP 6) REFERENCES APPENDICES KEYWORDS APPENDIX APPENDIX APPENDIX APPENDIX APPENDIX APPENDIX APPENDIX APPENDIX APPENDIX APPENDIX APPENDIX APPENDIX APPENDIX Document No: MDHB-5877 Page 1 of 38 Version: 2 Prepared by: Co-Ordinator Family Violence Intervention Programme, Director Issue Date: Original - 21/Oct/2010 Authorised by: Director, Patient Safety and Clinical Effectiveness Revised 03/May/2013 Class Code: TFV-YA MidCentral District Health Board CONTROLLED DOCUMENT. The electronic version is the most up-to-date version. MDHB will NOT take any responsibility in case of any outdated paper copy being used and leading to any undesirable consequence.

2 Policy for Child/Young Person Abuse and/or Neglect Child in Need Policy & Procedure 1. PURPOSE This policy provides MidCentral District Health Board (DHB) community and hospital based staff with a framework to identify and manage actual and /or suspected child abuse and neglect. It recognises the important role and responsibility staff have in the accurate detection of suspected child abuse/neglect and the early recognition of children at risk of abuse and adults at risk of abusing children 2. PRINCIPLES The rights, welfare and safety of the child/tamariki, young person/rangatahi are our first and paramount consideration. Health services should contribute to the nurturing and protection of children and advocate for them as part of their role to promote and preserve health. Health services for the care and protection of children are built on a bi cultural partnership in accordance with the Treaty of Waitangi. Maori tamariki/rangatahi are assessed and managed in a culturally safe environment. Te Whare Rapuora (Maori health Unit) is available for cultural support. Child, Adolescent & Family (CAF) and Oranga Hinengaro are available for support with mental health issues. Wherever possible the family/whanau participate in the decisions for the child/tamariki All staff are to recognise and be sensitive to other cultures MidCentral DHB provides an integrated service and works with external agencies to provide an effective and coordinated approach to child protection. Staff are competent in the identification and management of actual or potential abuse/neglect through the organisation s policy, procedures and education programme. 3. SCOPE This policy applies to all cases of actual and /or suspected child/young person abuse and /or neglect, encountered by employees, students and people working at DHB under a contract for service. 4. TERMS AND DEFINITIONS All terms and definitions related to this document have been defined. (See Appendix 1) 5. ROLES AND RESPONSIBILITIES Executive Responsibilities The MidCentral DHB is responsible for ensuring it has an organisation wide policy for the management of child abuse and neglect, regular training for staff in the policy, processes to ensure the policy is adhered to, such as clinical audits and adequate support and supervision for staff. Document No.: MDHB-5877 Page 2 of 38 Version: 2

3 Training Family Violence Intervention training is to be completed by all MidCentral staff working with children and women. The training includes: Pre-reading One day (8 hours) training session Staff will undertake refresher training as required. Appropriate specialist training will be offered to designated staff. Service Responsibilities All services who provide care for children and young persons will have service level child protection procedures based on this policy and procedure. All services will send a copy of Referrals sent to Child, Youth and Family to the Family Violence Intervention Co-ordinator. Staff Support, Safety and Supervision Clinical supervision and/or support is mandatory for all staff, where child abuse/neglect is suspected or confirmed, as an important requirement to ensure the practice of Child Protection remains safe for patients and staff. It is available within the service/department. Staff should also seek debriefing from an appropriately trained senior colleague. The Employee Assistance Programme is also available if further assistance is needed. Staff are encouraged to self refer on Employee Responsibilities All employees of MidCentral DHB have a responsibility for the management of suspected abuse and neglect. Responsibilities are: To be conversant with DHB policy and aware how to access it To know the procedures for suspected abuse and neglect To take action when child abuse is suspected or identified To attend core training and regular updates appropriate to their area of work To include MC Health Specialist services as appropriate: o o o o o Paediatric assessment Diagnostic medical assessments Cultural assessments Social work assessments, counselling and therapy resources Mental health assessments This includes situations where child abuse is disclosed but the child may not be present Document No: MDHB-5877 Page 3 of 38 Version: 2

4 Human Resource Responsibilities Policy for Child/Young Person Abuse And /Or Neglect Child In Need Policy& Procedure MidCentral DHB recruitment policies will reflect a commitment to child protection by including screening procedures. Where suspicion of child abuse and/or neglect by an employee in the DHB exists, the Code of Conduct Policy will guide processes. Family Violence Intervention Co-ordinator Responsibilities To conduct an annual review of compliance to policy To facilitate analysis of clinical management processes with the Child Protection Task Force. Ensure provision of training about child abuse/neglect is available To be available to staff for consultation regarding child protection issues and concerns To facilitate communication with Child, Youth & Family (CYF) MidCentral DHB Employees and Family Violence The MidCentral DHB Employee Assistance Programme is available to support employees experiencing or perpetuating family violence. Maori and the Family Violence Intervention Programme Maori are significantly over-represented as both victims and perpetrators of whanau violence. This should be seen in the context of colonisation and the loss of traditional structures of whanau support. However, violence is not a cultural norm nor is it traditional Maori. Maori are entitled to Interpreting services, if requested, as Maori is an official language. Family Violence intervention for Maori is based on victim safety with protection as the paramount principle. Practice needs to be clinically and culturally competent. Affirm with Women and children their right to be safe in their home. Staff from Te Whare Rapuora are available to support whanau and address cultural needs. If a request for support by a Maori health practitioner is not made, it is the responsibility of staff to ensure whanau are informed of culturally appropriate services. If whanau nominate a spokesperson, that person is to be consulted about processes and procedures. See Appendix 2 Pacific People s and the Family Violence Intervention Programme The complexity of Family Violence is also evident with Pacific people s culture. Intervention is base don victim safety with protection as the paramount principle. See Appendix 3 Document No: MDHB-5877 Page 4 of 38 Version: 2

5 PROCEDURAL FLOWCHART FOR MID CENTRAL HEALTH The following flowchart is produced as simplified guide to practice: CHILD ABUSE AND NEGLECT: ASSESSMENT AND RESPONSE A Brief Intervention Model 6 Step Process Possible child abuse and neglect ensure safety of the child Identify (step 1) Support child and family (step 2) If urgent care required refer for treatment Initial Assessment (step 3) Gather information Consult appropriate people Record Discuss with team TEAMS Do not work alone. Consult with others, e.g.: Consultant Paediatricians Social Worker Charge Nurse Clinical Coordinator Mental Health Family Violence Intervention Coordinator Child, Youth & Family Service NO Is there an abuse issue to consider? YES Are there other issues/ concerns to address? Is abuse Serious Life threatening * Assess risk of partner abuse NO- but at risk YES NO No further action Record YES Safety Planning (step 4) Gather information Discuss with team Plan assessment *Assess risk of partner abuse Safety Planning Inform Senior Staff Ensure CYF / Police contacted immediately Complete written report to Multi Agency Safety Plan with DHB staff, Police, CYF (steps 4, 5 and 6) Documentation record (step 5) *Refer to Partner Abuse (Family Violence) Policy/procedure Referral (step 6) Refer to appropriate agency Follow up: Written report to CYF in consultation with Consultant Paediatricans Complete Alert form and forward to Clinical Record to input Record all follow up action Document No: MDHB-5877 Page 5 of 38 Version: 2

6 6. PROCEDURES FOR RESPONDING TO ACTUAL/SUSPECTED ABUSE/NEGLECT All situations where child abuse /neglect is disclosed, detected or suspected must be acted upon using the following procedure. The following outlines the standard process for assessment and response. Service Level procedures will detail specific actions for your Service. Consultation NEEDS to occur throughout the process as Child Protection is carried out by a multi disciplinary team. Generally no one person would complete all 6 Steps and even then consultation needs to occur. Training is essential before working with abused children/youth. A Brief Intervention Model, a Six Step Process Step 1 - Identify Step 2 - Support & empower Step 3 - Assess risk Step 4 - Safety planning & referral Step 5 - Documentation Step 6 - Referral 6.1 Identify (Step 1) Either by disclosure or recognition of signs and symptoms The following staff are available for consultation Experienced colleague(s) Consultant Paediatrician on call Clinical Co-ordinator of your Service. Clinical Co-ordinator, Social work Paediatric social worker Charge nurse Family Violence Intervention Co-ordinator The Ministry of Health Cue Cards provide a helpful outline of the 6 step process. They are Distributed at training and are also available from the FVI Co-ordinator. Refer to Appendix 1 for Definitions of Child abuse/neglect. Refer to Appendix 4 for Signs and Symptoms for each category. 6.2 Support and Empower Victims of Child Abuse/Neglect (Step 2) Provide non judgemental emotional support to the child and/or their family and say that help is available. Enlist social work support if required / necessary. If child/family identify as Maori consult with whanau if they wish Te Whare Rapuora to provide cultural support. Document No: MDHB-5877 Page 6 of 38 Version: 2

7 Do not discuss concerns or child protective actions with caregivers/parents if: If it will place the child or yourself in danger. Where the family may close ranks and reduce the possibility of keeping the child safe. The family may take flight to avoid follow up. 6.3 Assess Risk (Step 3) Consult with colleagues (see Step 1) Refer to Appendix 5 for High Risk Indicators associated with Child Abuse/neglect IF Child is to be questioned directly care needs to be taken not to place the child at further risk. Risk indicators in the child s environment Any history of previous abuse/neglect or suspected Family violence Parent indifferent, intolerant-view child as particularly trouble some Severe social stress Severe isolation and lack of supports Alcohol/other drug issues Mental illness including postnatal depression Very young parents Frequents changes of address- more than 2 in the last year Family actively avoids contact with health care providers/family support agencies. Assess Risk what is happening to the child? Review all episodes of care to identify current or previous contact with DHB services. If child abuse/neglect is suspected a child or young person may be admitted to hospital to enable a safety assessment to be completed. Refer to Appendix 6, Guidelines to Accessing Information Nature of abuse, neglect or risk Details of: What, Where, When, How, Who saw it happen? What is the trend? Increasing, decreasing, static Assess safety of other siblings in the household Who are the adequate protectors available? i.e. an adult who will kept the child safe, family, other support people in child s life Child s ability to protect self Other agencies involved with family RED FLAGS Uncorroborated history Discrepancy between history and the incident Changing history History of repeated trauma/incidents Document No: MDHB-5877 Page 7 of 38 Version: 2

8 Delay in seeking medical advice Inappropriate parental response Sudden change in child s behaviour Unusual child/parent interaction Do Not Further Interview the Child Death of a Child and Sibling Assessment If a child is brought into the DHB and is deceased on arrival or the child dies in the DHB and the cause of death is suspicious, then an assessment of the safety of any siblings should be urgently undertaken. The paediatrician on call should determine if there are other siblings and if so report this to CYF. Assess for Co-occurrence of partner abuse If child abuse/neglect is suspected screen the mother for partner abuse, but not if other adults or children over 2 are present. There is substantial overlap between the occurrence of child abuse and partner abuse in families. Interventions need to jointly address both issues. If a pregnant woman is experiencing Partner abuse a referral must be made to the DHB Clinical Co-ordinator of social work. A Child Safety Intervention Plan will be considered in consultation with yourself, other relevant professionals, agencies and family. Refer to the Partner Abuse Policy/procedure. 6.4 Safety Planning/Intervention (Step 4) If there are concerns about the immediate safety of a child (or yourself) contact the police. Security will assist if concerns about child safety are identified. A When a child presents to the DHB with suspected abuse /neglect Or with abuse and no identified abuser Reporting to Child, Youth and Family must be made at the earliest opportunity, in consultation with colleagues, If: Injuries which seem suspicious, or are clearly the result of physical or other abuse Interaction between the child and parent(s) /caregiver seems angry, threatening, aggressive or disinterested. Child says they are fearful of parent(s) /caregiver, or have been hurt by parent(s) /caregiver If multiple risk factors exist e.g. partner abuse in the relationship, alcohol/drug use, avoidance of health agencies Notify CYF on 0508 FAMILY, followed by a written referral using the Child, Youth and Family Referral document Place an Alert using the Abuse Alert Notification form and sending to Clinical Records to input Document No: MDHB-5877 Page 8 of 38 Version: 2

9 Refer to Appendix 7 Referral form to CYF Send a copy to the Family Violence Intervention Co-ordinator. The Child Young Persons and their Family Act provides specific protection from legal action, to anyone reporting child abuse/neglect to CYF, in good faith. Refer to Appendix 8 for Legal and Privacy issues B If a child is admitted to hospital with suspected abuse or identified abuse/neglect A Multi Agency Safety plan (MASP) must be completed before the child is discharged from hospital. This is a comprehensive plan completed with all relevant DHB staff, (may include paediatrician, children s ward charge nurse, paediatric social worker, Family Violence Intervention Co-ordinator), CYF, including the CYF hospital social worker and the police. Child safety, while admitted to hospital, is part of the MAS Plan Refer to Appendix 10 Supervision options for a child admitted to hospital with actual or suspected abuse/neglect. C Consider Child Sexual abuse if Caregiver raises concerns Child/adolescent discloses The history or examination raises concerns that sexual abuse may have occurred Social/Medical issues A child who presents with symptoms or a disclosure suggestive of child sexual abuse must be seen by a paediatrician or DSAC (NZ Association of Sexual Assault Clinicians) trained doctor. DSAC doctors and nurses have access to appropriate facilities (at a special purpose clinic at Southern Cross) to maintain a chain of evidence, provide expert witness for court purposes Do not interview the child or adolescent. This is a specialist interview for the police and/or CYF Reassure the child that it is good that they have disclosed and that a person with special skills will talk with them about what has happened If appropriate take a brief history from the caregiver-behavioural changes, physical symptoms, what the child has said, and other relevant history. Refer to Appendix 9 for Guideline for Responding to Child Sexual Abuse Remember admitting a child to hospital does not ensure their safety D Other issues or concerns about a child s care/wellbeing, but not at the level of child abuse Refer to an agency for: Document No: MDHB-5877 Page 9 of 38 Version: 2

10 Social supports Parenting skills Well child services Refer to MidCentral DHB services e.g. Social work Child development Paediatrician Child, Adolescent and Family (CAF) Oranga Hinengaro E Communication with the child s parent(s)/caregivers There must be an agreed and documented decision on who will be responsible for any discussions with the family about the concerns for the child wellbeing. This may vary between cases and services (see unit specific policies). These discussions should not take place before consulting with senior staff within your practice setting. Ideally the MASP meeting should be convened first. If the decision is to discuss concerns or child protection actions with a child s family the delegated staff member must understand and acknowledge the sensitivity of the situation. Remember discussions DO NOT need to happen if it would place the child or yourself at risk, Family could close ranks, or may seek to avoid protection agency staff 6.5 Documentation (Step 5) Document all observations, process and assessment thoroughly In all cases accurate informative documentation is essential and must be recorded in the Health Record with time, date, legible signature and designation. State the alleged suspected abuser(s) name if known and record their relationship to child. Consider using the Suspected Child Abuse/Neglect Assessment form for a comprehensive documentation, especially for serious abuse and neglect. It is available on the Intranet. Document facts and observations as soon as possible after the event or discussion o o o o o o Record only facts and/or observations not feelings. Clearly differentiate between what was seen and heard and what was reported or suspected and by whom. Detail who was present at the time. Include date and time. Where there has been a disclosure, write what was said in quotation marks (verbatim). The body diagram should be used to record bruises, cuts and other injuries both old and new. Document No: MDHB-5877 Page 10 of 38 Version: 2

11 Refer to Appendix 11 Policy for Child/Young Person Abuse And /Or Neglect Child In Need Policy& Procedure o o Record whether you think the injury is consistent with the caregivers explanation. Note action taken, referral information offered and follow up arranged. The documentation you take can be a powerful intervention on the child s behalf. 6.6 Referral (Step 6) If following a comprehensive risk assessment and appropriate consultation abuse is identified or suspected then the child/children should be reported to the Police and or CYFS as identified in Section 4. The report to CYFS can be by phone but must be followed by an e mail or faxed written report. DHB Family Violence Co-ordinator must be advised of all notifications. Send a copy of the notification. When you are concerned about the child s care, but not to the extent requiring reporting to CYFS then refer to a DHB Social Worker, DHB service or appropriate community agency to enlist support for the family as identified in Section 4. Refer to Appendix 12 Consent Authorised persons working under section 125 have the statutory power to enter schools or early childhood centres to examine a child without a court order or parental consent (Health Act 1956 s125 par (2), Ministry of Health Guidelines July 1993). These authorised persons are: a medical officer employed in the Ministry a person authorised by the Ministry of Health, e.g. Public Health Nurses a person employed by Plunket Permission of a parent or guardian is normally required for any medical examination of a child under 16 years with regard to child abuse. Exceptions are: if the child or young person is placed under the guardianship of the Chief Executive of the Ministry of Social Development by section 110 of the Children, Young Person and Family Act (1989). Where a child or young person is placed under section 39, 40, or 42, of the CYPF Act 1989, the social worker can ask for a medical examination without the prior consent of the parent or guardian. However they need to have made reasonable efforts to get that consent. Alternatively a Court can order a medical examination be carried out. No examination carried out under section 53 of the Children, Young Person and Family Act 1989 at the request of a social worker, shall include an internal examination of the genitals or anus unless the medical practitioner believes the child may have been subject to recent physical Document No: MDHB-5877 Page 11 of 38 Version: 2

12 or sexual abuse and the child consents to the examination. The need for the child's consent is waived in cases when the child is too young to consent. No general anaesthetic may be administered. A child is entitled to nominate, and to have a supportive adult present during medical examinations. (Children, Young Person and Family Act 1989 section 54) Family Safety and Security Process At times it is necessary to suppress patients details and/or to provide secure processes, including at the time of discharge. Refer to Appendix 13 Family Safety and Security Guidelines 7. REFERENCES Organisation Documents: Child Abuse and Neglect Policy Partner Abuse Policy Suspected Child Abuse and Neglect Assessment Form Debriefing Policy Following a Critical Incident (DHB/ doc) Event Reporting Policy (DHB/doc) Informed Consent Policy (DHB/doc) DHB Unit Specific procedures/policies Privacy Sending Correspondence by Fax (DHB/doc) Faxing document Health Records Policy Documenting Care and Treatment in the Health Record (doc) Privacy General Guidelines Policy (DHB/doc) Privacy Release of Health Information Policy (DHB/doc) Privacy Collection of Health Information (DHB/doc) Tikanga Best practice Policy (DHB/doc) Security Policy (DHB/doc) Alerts Policy Legislation: Health Act (1956) Children s Young Persons and their Families Act (1989) (and Amendments 1994/95) Privacy Act (1993) and Health Information Privacy Code (1994) Code of Health and Disability Services Consumers Rights (1996) New Zealand Bill of Rights (1990) Crimes Act (1961) Domestic Violence Act (1995) Guardianship Act (1968) Summary Offences Act (1981) Other: Children s Commissioner. Safety of Children in Hospital. Wellington: Office of the Commissioner for Children, Document No: MDHB-5877 Page 12 of 38 Version: 2

13 Family Violence. Guidelines for Health Sector Providers to Develop Practice Protocols. Ministry of Health 1998 Fanslow, J. Family Violence Intervention Guidelines. Wellington, Ministry of Health, DHB and Eastern Service Centre Child Youth and Family Service. Memorandum of Understanding between Children & Youth Acute and Elective services and the Eastern Service Centre Child Youth and Family Service For further information contact the Family Violence Intervention Co-ordinator 8. APPENDICES Appendix 1 Appendix 2 Appendix 3 Appendix 4 Appendix 5 Appendix 6 Appendix 7 Appendix 8 Appendix 9 Appendix 10 Appendix 11 Appendix 12 Appendix 13 Terms and Definitions Maori and Family Violence Pacific Peoples and Family Violence Signs and Symptoms Associated with Child Abuse/Neglect High Risk Indicators Associated With Child Abuse and Neglect Guidelines for Accessing Information Referral Fax To Child, Youth and Family Legal and Privacy Issues Guideline for Responding To Child Sexual Abuse Supervision Options for a Child Admitted With Actual or Suspected Child Abuse Documentation Form For Child Abuse and Neglect Family Violence Services Family Safety and Security Guidelines 9. KEYWORDS Child abuse, Family violence, Partner abuse, Physical abuse, Emotional abuse, Psychological abuse, Sexual abuse, Neglect, Child in need, Multi agency safety plans (MASP), Brief intervention- A 6 step model, Child youth and family (CYF), Child safety intervention plan (CSI), Doctors for sexual abuse care (DSAC) Document No: MDHB-5877 Page 13 of 38 Version: 2

14 Child Appendix 1 Child Protection Child Abuse Physical Abuse Sexual Abuse Emotional/ Psychological Abuse Neglect TERMS AND DEFINITIONS In this document the word child refers to child/tamariki and young person/rangatahi ages 0-16 inclusive. It also includes an unborn baby Means the activities carried out to ensure the safety of the unborn baby, child/tamariki, young person/rangatahi in cases where there is abuse or risk of abuse. Refers to the harming (whether physically, emotionally, or sexually), ill treatment, abuse, neglect, or serious deprivation of any child/tamariki, young person/rangatahi (Section 14b Children, Young Persons and their Families Act 1989). This includes actual, potential and suspected abuse. Child physical abuse is any act or acts that may result in inflicted injury to a child or young person. It may include bruises, welts, cuts, abrasions, fractures or sprains, head injuries, internal injuries, strangulation, suffocation, burns/scalds and poisoning, including ingestion of alcohol and other drugs. Child sexual abuse is any act or acts that result in the sexual exploitation of a child or young person, whether consensual or not. This may include but is not restricted to direct sexual contact with the child, masturbation, exhibitionism, exposure to pornography or involvement in pornography/prostitution, suggestive behaviours or comments. Child emotional/psychological abuse is any act or omission that results in impaired psychological, social, intellectual and/or emotional functioning and development of a child or young person. This includes, but is not restricted to, rejection, isolation, lack of affection, threats, continued criticism, humiliation, inappropriate expectations, Exposure to Family Violence Child neglect is any act or omission that results in impaired physical functioning, injury, and/or development of a child or a young person. It may include: Physical neglect failure to provide the necessities to sustain the life or health of a child Neglectful supervision Failure to provide developmentally appropriate and/or legally required supervision Medical neglect- failure to seek, obtain or follow through with medical care for the child resulting in impaired functioning or development Abandonment-leaving a child without arranging for necessary care for them Refusal to assume parental responsibility- unwilling or unable to provide appropriate care or control of the child Document No: MDHB-5877 Page 14 of 38 Version: 2

15 DSAC Child Youth and Family (CYF) Doctors for Sexual Abuse Care. National organisation advancing knowledge and improving medical care for those affected by sexual abuse. Only DSAC trained practitioners should perform medical examinations for child sexual assault. Government agency that carries out the legislative requirements of the Children, Young Persons, and their Families Act Responsibilities are: To investigate cases of actual and suspected child abuse and/or neglect To complete evidential interviews in cooperation with NZ Police To provide care and protection for children found to be in need NZ Police Domestic Abuse Government agency responsible for: Working cooperatively with Child, Youth and Family in child abuse and/or neglect protection work Investigating cases of abuse and/or neglect where an offence has or may have been committed Prosecuting offenders where an offence has been committed Accepting reports of suspected abuse and or neglect and referring these to Child, Youth and Family. Domestic Violence Act 1995, Section 3 (1) In this Act domestic violence in relation to any person, means violence against that person by any other person with whom that person is, or has been in a domestic relationship. It includes physical, sexual, psychological (intimidation, harassment, damage to property, threats of abuse) abuse and causing/allowing a child to be put at real risk of seeing or hearing the domestic abuse which is occurring. A domestic relationship includes: Spouse/partner of the person Is a family member of the person Ordinarily shares a household with the person, includes boarders and flatmates Has a close personal relationship with the other person Includes lesbian, homosexual, bisexual, transgender relationships Child in Need Multi Agency Safety Plan A child is in Need if the child is unlikely to achieve or maintain a reasonable standard of health or development without the provision of community services/resources. Children/young people admitted to hospital because of child abuse /suspected child abuse must have a Multi Agency Safety plan to ensure their safety before they are Document No: MDHB-5877 Page 15 of 38 Version: 2

16 (MASP) Child Safety Intervention Plan(CSI) discharged. This plan is written collaboratively by CYF, health professionals, police and family if appropriate. There is a template to guide these plans. This is a Ministry of Social Development initiative and the completion of the plan by the 3 agencies is compulsory. A collaborative plan between MidCentral DHB, CYF and any other relevant agencies to proactively plan healthy outcomes for pregnant women and their unborn child. It is facilitated primarily by the maternity social worker. Refer to the Clinical Co-ordinator of social work. There are guidelines and a template Document No: MDHB-5877 Page 16 of 38 Version: 2

17 Appendix 2 MAORI AND FAMILY VIOLENCE This section from the Family Violence Intervention Guidelines was developed with consultation from the Ministry of Health Family Violence Maori Advisory Committee. This appendix offers some background and context for family violence in relation to Maori, and identifies key principles and actions for effective screening, assessment and intervention of domestic violence and child abuse/neglect. The experience of family violence for Maori is complex. The historical context and process of colonisation have distanced Maori from their traditional roles and social supports. With the breakdown of traditional whanau structure, loss of beliefs and values, including te reo Maori, patterns of behaviour have emerged. For some Maori family violence is no longer viewed as prohibited and the traditional sanctions are no longer in place. Violence impacts negatively on whanau, hapu and iwi. The Violence Intervention Programme (VIP) has developed this programme within the founding principles of the Treaty of Waitangi. Principles of Action E tau hikoi I runga I oku whariki E tau noho I toku matapihi E hau kina ai toku tatau toku matapihi Your steps on my whariki (mat), your respect for my home, Opens my doors and windows. Health care providers should ensure the service they provide is safe and respectful of Maori women s beliefs and practices. The delivery of culturally safe and competent intervention that responds to Maori victims is supported by the following principles: Victim safety and protection are paramount Maori-friendly environment Culturally safe and competent interactions Engagement of local iwi, hapu and whanau Knowledge of the community Intersectorial collaboration Monitoring and evaluation of family violence interventions with Maori women and children. Victim Safety Maintaining safety of women and children is paramount. This includes only questioning women about abuse when they are alone or accompanied by children under 2 years Affirm women s and children s right to a safe, non-violent home Have Maori staff available when possible, this may include Kaumatua or Kuia who can provide support. Routinely screen Maori women for violence Offer women options about possible plans of action they would like to take Document No: MDHB-5877 Page 17 of 38 Version: 2

18 The Provision of a Maori-Friendly Environment Ensure there are Maori images within the environment of the health care service, such as posters, signage and Maori designs Having Maori on staff Convey a genuine attitude that is gentle, welcoming, caring, non-judgemental and respectful Do not rush. Leave time to think about and respond to questions Ask open-ended questions Offer resources and support. The Provision of Culturally Safe and Competent Interactions Engage the MidCentral DHB Maori Health Unit Te Whare Rapuora to provide cultural guidance an /or Oranga Hinengaro All DHB staff are required to attend cultural training A Collaborative Community Approach to Family Violence Should Be Taken Staff should be aware of the referral agencies appropriate for Maori women and children who are victims of abuse Do not assume that the whanau should be involved in supporting the women and child(ren) - ask the women what plan of action they want (it may or may not include the whanau Document No: MDHB-5877 Page 18 of 38 Version: 2

19 Appendix 3 PACIFIC PEOPLES AND FAMILY VIOLENCE There are seven main Pacific communities represented in New Zealand, Samoa, Tuvalu, Tokelau, Fiji, Tonga, Niue, and the Cook Islands. Family violence among Pacific communities in New Zealand occurs in the context of social change brought about by the migration from the Pacific, alienation from traditional concepts of the village, family support, extended family relationships and in combination with the socio-economic stressors, for example scarce resources may be stretched between the demands of everyday living as well as customary obligations, such as those to the church and remittance to family members who have remained in the Pacific. Victim Safety Maintaining safety of women and children is paramount, this includes only questioning women about abuse when they are alone or accompanied by children under 2 years. Affirm women and children s right to a safe, non-violent home Routinely screen Pacific women for violence The Provision of a Pacific-Friendly Environment Convey a genuine attitude that is gentle, welcoming, caring, non-judgemental and respectful Do not rush, leave time to think about and respond to questions Ask open-ended questions Offer resources and support that meets the ethnic specific needs of the victim Have Pacific staff available. The Provision of Culturally Safe and Competent Interactions Develop knowledge and understanding about the dynamics of family violence and victims who are from the Pacific culture. Identify and remove barriers for Pacific women and children accessing health care services All DHB staff are required to attend cultural training Pacific protocols are observed where possible Qualified interpreters are to be used where appropriate ring telephone operator. A Collaborative Community Approach to Family Violence Should Be Taken Staff should be aware of the referral agencies appropriate for Pacific women and children who are victims of abuse Do not assume that the family or church should be involved in supporting the women and child(ren)- ask the women what plan of action they want (it may or may not include the family and the church). Document No: MDHB-5877 Page 19 of 38 Version: 2

20 Appendix 4 SIGNS & SYMPTOMS ASSOCIATED WITH CHILD ABUSE & NEGLECT The signs, symptoms, and history described below are not diagnostic of abuse. However in certain situations, contexts and combinations they will raise the practitioner s suspicion of abuse. It is better to refer on suspicion. If you wait for proof, serious harm can occur. HISTORY History inconsistent with the injury presented Past abuse or family violence Exposure to family violence, pornography, alcohol or drug abuse Isolation and lack of support Mental illness, including post-natal depression Inappropriate or inconsistent discipline (especially thrashings or any physical punishment of babies) Neglecting the child Delay in seeking help Disclosure by the child Severe social stress Parent/s abused as child/children Unrealistic expectations of child Terrorising, humiliating, or oppressing Promoting excessive dependency in the child Actively avoiding seeking care or shopping around for care (frequent changes of address) PHYSICAL SIGNS Multiple injuries, especially of different ages; bruises, welts cuts, abrasions Scald and burns, especially in unusual distributions such as glove and sock patterns Pregnancy Genital injuries Sexual transmitted diseases Patterned bruising Unexplained failure to thrive (FTT) Poor hygiene Dehydration or malnutrition Fractures, especially in infants or in specific patterns Poisoning, especially if recurrent Apnoeic spells, especially if recurrent BEHAVIOURAL AND DEVELOPMENT SIGNS Aggression Anxiety and regression Obsessions Overly responsive behaviour Frozen watchfulness Sexualised behaviour Fear Sadness Defiance Post traumatic Stress Disorder Self-mutilation Suicidal thought/plans Withdrawal from family Substance abuse Overall developmental delay, especially if also inorganic Failure to thrive (FTT) Patchy or specific delay: motor, emotional, speech and language, social, cognitive, vision and hearing Document No: MDHB-5877 Page 20 of 38 Version: 2

21 Appendix 5 HIGH RISK INDICATORS ASSOCIATED WITH CHILD ABUSE AND NEGLECT Child characteristics which may predispose them to be at risk Child with a congenital abnormality, either mental or physical Premature infant or ill newborn who is separated during the neo-natal period Colicky or irritable child Child who is rigid or non-cuddly Child who is unwanted Child who is not the gender expected/desired by the parents Foster child, adopted child or step-child Child who is intellectually impaired, highly intelligent or hyperactive Child is particularly difficult (or is seen as difficult) Caregiver s perceptions of child that may predispose some children to be at risk Bad, naughty or manipulative Difficult and unrewarding to care for Unloving or rejected by the parents Resembling a disliked person in appearance, behaviour or temperament A rival for attention or affection that parents themselves desire Family factors that may place children at higher risk of abuse Partner abuse is present Parent was abused or seriously neglected as a child Parent has serious mental health problems Parent has had frequent trouble with the law Parent has an alcohol or drug problem Parent has rigid or unrealistic expectations of child Previous abuse towards this or another child Parent has violent temper or outburst toward things or people Family socially isolated Parents with low self-esteem Parent is a teenager Family suffers from multiple crises Parent administers harsh or unusual punishment From: Child Abuse Indicators: Information for General Practitioners and Community Workers Child and Adolescent Health Service, Taranaki Healthcare (1993, Second Edition) Document No: MDHB-5877 Page 21 of 38 Version: 2

22 Appendix 6 GUIDELINES FOR ACCESSING INFORMATION Where there are any concerns regarding actual or suspected abuse all available information must be accessed. Track health records for location of relevant information. Search for episodes of care: o o o o If there is an inpatient or ED file contact medical records office or duty manager after hours. If there is a Community Health file, contact appropriate DHB service. If there is a Mental Health file contact Mental Health Service or Access Centre. To check if a Family Violence Identification form has been previously filed at Clinical Records for the child s mother, go to her patient registration screen, fill in LE (local event) in the Enter field number/code box. On the next screen Local events-it will record P.FVIF which tells you a FVI form exists. Se Partner/Family Violence policy/procedure If more detail is required contact other hospitals for relevant data. The search can be done at the same time of reporting. It is important that the reporting should not be delayed. Document No: MDHB-5877 Page 22 of 38 Version: 2

23 Appendix 7 MDHB-5420 Policy for Child/Young Person Abuse And /Or Neglect Child In Need Policy& Procedure Document No: MDHB-5877 Page 23 of 38 Version: 2

24 Document No: MDHB-5877 Page 24 of 38 Version: 2

25 Document No: MDHB-5877 Page 25 of 38 Version: 2

26 Document No: MDHB-5877 Page 26 of 38 Version: 2

27 Document No: MDHB-5877 Page 27 of 38 Version: 2

28 Appendix 8 LEGAL AND PRIVACY ISSUES Since the introduction of the Privacy Act (1993) and the Health Information Privacy Code (1994), agencies and individuals have become concerned about how much information can be given to statutory social workers or the Police. Both documents make provision for the disclosure of information necessary to prevent harm to any individual. As well, all privacy restrictions are over-ridden by certain sections of the Children, Young Persons and their Families Act (1989). These provide for the reporting of child abuse, protection of an individual from proceedings when disclosing child abuse to either a statutory social worker or police, and government agency obligations DHB encourages good communication between DHB staff and CYFS or the police to keep children safe. Requests for information should be referred directly to unit managers, who are responsible for ensuring such requests are dealt with promptly and appropriately. Information must only be released to a CYFS social worker, police officer or care and protection coordinator (s66 CYF Act: see below). Health workers therefore, are able to give information to the Child, Youth and Family or police Both by reporting abuse or when requested by either agency. CHILDREN, YOUNG PERSONS AND THEIR FAMILIES ACT S15 Reporting of ill treatment or neglect of child or young person Any person who believes that any child or young person has been, or is likely to be, harmed (whether physically, emotionally, or sexually), ill-treated, abused, neglected, or deprived may report the matter to a social worker or a member of the police. S16 Protection of person reporting ill treatment or neglect of child or young person No civil, criminal, or disciplinary proceedings shall lie against any person in respect of the disclosure or supply, or the manner of the disclosure or supply, by that person pursuant to section 15 of this Act of information concerning a child or young person (whether or not that information also concerns any other person), unless the information was disclosed or supplied in bad faith. S66 Government Departments may be required to supply information (1) Every Government Department, agent, or instrument of the Crown and every statutory body shall, when required, supply to every Care and Protection Co-ordinator, CYFS social worker, or member of the police such information as it has in its possession relating to any child or young person where that information is required - (a) For the purposes of determining whether that child or young person is in need of care or protection (other than on the ground specified in section 14 (1)(e) of this Act): or (b) For the purposes of proceedings under this part of this Act. Document No: MDHB-5877 Page 28 of 38 Version: 2

29 Section 66 means that where a care and protection coordinator, CYFS social worker or police officer requires information about a child/young person for the purposes of determining whether the child/young person is in need of care and protection, or for proceedings under the CYF Act, DHB staff must provide that information. A staff member may be asked to provide this information in an affidavit. DHB recommends that the staff member seeks the support and advice of the unit manager, DHB s child protection coordinator and/or DHB s legal adviser. Principle 11 (f) (ii) PRIVACY ACT An agency may disclose information if that agency believes, on reasonable grounds that the disclosure of the information is necessary to prevent or lessen a serious and imminent threat to the life or health of the individual concerned or another individual Rule 11 subsection 2 (d) (ii) HEALTH INFORMATION PRIVACY CODE An agency that holds personal information must not disclose the information to a person or body or agency unless the disclosure of that information is necessary to prevent or lessen a serious and imminent threat to the life or health of the individual concerned or another individual HEALTH ACT 1956 Section 22 (2) (c) Disclosure of health Information Any person being an agency, that provides health services or disability services may disclose health information to a social worker or a Care and Protection Co-ordinator within the meaning of the Children Young Persons and their Families Act (1989), for the purposes of exercising or performing any of that person s powers under that Act. Always seek advice prior to release of information (refer to Privacy policies in the Operational Policy Manual in the first instance and/or the Risk Manager). Document No: MDHB-5877 Page 29 of 38 Version: 2

30 Appendix 9 GUIDELINE FOR RESPONDING TO CHILD SEXUAL ABUSE Paediatric (0 16 yrs) Ensure immediate Medical safety Discussed with/seen by: Senior ED Clinician / Paediatrician / GP Do not question further Document What you observe, what you are told Contact Child Youth & Family &/or Police CYF / Police assess if need for urgent forensic examination if abuse has occurred within h CYF will arrange evidential interview Doctors for Sexual Abuse Care exam Routine Letter to GP Offer referral to Abuse, Rape Crisis Support, for follow-up Counselling support One specialist examination is enough Document No: MDHB-5877 Page 30 of 38 Version: 2

31 Appendix 10 SUPERVISION OPTIONS FOR A CHILD ADMITTED WITH ACTUAL OR SUSPECTED CHILD ABUSE Child admitted to ward, with suspected Non-accidental injury (NAI): Assessment ongoing Child admitted to ward, suspected NAI. Notified to CYF: Perpetrator identified Child admitted to ward, suspected NAI. Notified to CYF: Perpetrator not identified Visits Options include: Designated visitors only Visits supervised Visitors banned Supervision If supervision is required: By arrangement with ward staff in consultation with Clinical Charge Nurse/shift co-ordinator Responsibility of MidCentral DHB until CYF notified Once CYF notified then responsibility for the child s safety is shared between DHB and CYF. Child admitted to ward, under care of CYF A copy of the Multi agency Safety Plan is held by the Charge Nurse. Visits are in accordance with the plan. If supervision is required: By arrangement with ward staff Responsibility of DHB to ensure visits are supervised, but not to provide supervision Responsibility of CYF to provide supervision in accordance with MASPlan Document No: MDHB-5877 Page 31 of 38 Version: 2

32 Appendix 11 MDHB-4802 Policy for Child/Young Person Abuse And /Or Neglect Child In Need Policy& Procedure BODY MAP DOCUMENTATION FOR CHILD ABUSE (ATTACH TO CLINICAL RECORDS) Patient Label Printed Name (Consultant): Signature: Date: Time: Document No: MDHB-5877 Page 32 of 38 Version: 2

33 Printed Name (Consultant): Patient Label Signature: Date: Time: Weight: (percentile) Height: (percentile) Head Circumference: (percentile) Document No: MDHB-5877 Page 33 of 38 Version: 2

34 Appendix 12 FAMILY VIOLENCE SERVICES There is consumer group overlap with many of these agencies WOMEN S SERVICES Palmerston North Women s Refuge- Safe house, Women s Group Programme, Children s Group Programme, Home support PH Te Roopu Whakaruruhau Maori Women s Refuge, Women s Programme, Home Support, Safe House PH Abuse and Rape Crisis Support (ARCS) Manawatu Support and Counselling to those affected by Sexual Violence and after hours support line PH Relationship Services, Court approved Individual Protected Persons Programme for women with a Protection Order and Individual Preventing Violence Programmes PH or Te Manawa Services Living Free From Violence Women s Group Programme, Family Support service if Male Partner in Men s programme PH Te Runanga o Raukawa Social Services Whare o Rongo Domestic Violence Training for Women and individual counselling Palmerston North PH , Feilding PH Palmerston North Women s Health Collective Provider of women s health and wellbeing services including Counselling and advocacy, support and referrals PH Camellia House Providers of supportive and safe short-term accommodation for women and children PH DSAC Doctors for Sexual Abuse Care. Drs who are trained in the medical care of women, men and children who are sexually abused. In Manawatu, Southern Cross Hospital has a Specialist unit with trained staff. PH CHILD AND YOUTH SERVICES VOYAGE- Abuse and Rape Crisis Services Manawatu Group Programme for Children 5-11 who have been or seen any form of abuse PH Dragonflies-Palmerston North Women s Refuge Children s programme 5-12 yrs who have witnessed or experienced family violence PH Te Manawa Child Advocacy Service- Home visits with children and safe parent to discuss issues resulting from family violence and designing a safety plan PH Document No: MDHB-5877 Page 34 of 38 Version: 2