POLICY Number: 7311-50-007 Title: Suspected Child Abuse Authorization [ ] President and CEO [X ] Vice President, Finance and Corporate Services Source: Director, Interprofessional Practice, Education and Research Cross Index: Date Approved: June 12, 2012 Date Revised: May 19, 2016 Date Effective: June 27, 2016 Date Reaffirmed: Scope: SHR Any PRINTED version of this document is only accurate up to the date of printing. Saskatoon Health Region (SHR) cannot guarantee the currency or accuracy of any printed policy. Always refer to the Policies and Procedures site for the most current versions of documents in effect. SHR accepts no responsibility for use of this material by any person or organization not associated with SHR. No part of this document may be reproduced in any form for publication without permission of SHR. DEFINITIONS Apprehension occurs when a child is believed to be in need of protection. The Ministry of Social Services (MSS) brings the child into their care for the safety of the child. Child Protection Agency means an agency designated by the MSS and includes the First Nations Child and Family Service Agency. Child Abuse 1 means: Physical Abuse refers to all actions resulting in non-accidental physical injury or harm. Sexual Abuse and Exploitation occurs when the child has been or is likely to be exposed to harmful interaction for a sexual purpose by a parent, caretaker, any person in a position of trust and or any other person. It can include both physical and non-physical contact (see Appendix A). Age of consent or the age of protection refers to the age at which a young person can legally consent to sexual activity. The age of consent for sexual activity is 16 years. 2 However, the age of consent is 18 years where the sexual activity exploits the young person, such as when it involves prostitution, pornography or occurs in a relationship of authority, trust or dependency. 3 Physical neglect refers to acts of omission on the part of a parent/caregiver. This includes failure to provide for the child s basic needs and appropriate level of care. 1 Saskatchewan Child Abuse Protocol, 2014 2 Criminal Code, Canada 3 The Emergency Protection for Victims of Child Sexual Abuse and Exploitation C-E-8.2 s.4(1) Page 1 of 13
Emotional Maltreatment refers to both emotional abuse and emotional neglect of the child. Exposure to domestic violence or severe domestic disharmony includes children living in a situation and or witnessing, hearing or being aware of violence. Failure to provide essential medical treatment refers to a parent or caregiver failing to provide essential medical treatment or to remedy a mental, emotional or developmental condition of a child. SHR staff means all employees, practitioner staff, professional staff, contractors, students and volunteers. Suspected child abuse means suspected abuse of a person under the age of 16. 4 Suspected child sexual abuse means suspected sexual abuse of a person who is under the age of 18. 5 1. PURPOSE The purpose of this policy is to establish reporting requirements for Saskatoon Health Region (SHR) staff in instances of suspected Child Abuse pursuant to: The Child and Family Services Act, Saskatchewan, The Emergency Protection for Victims of Child Sexual Abuse and Exploitation, Saskatchewan and the Saskatchewan Child Abuse Protocol. 2. PRINCIPLE 3. POLICY 2.1 SHR recognizes that any child can be at risk of temporary or permanent injury as a result of Child Abuse. 2.2 Duty to report suspected Child Abuse on reasonable grounds supersedes the fiduciary duty of confidentiality. 6 3.1 All SHR Staff must report to a Child Protection Agency or a police service in all instances of suspected Child Abuse 7 and/or suspected child sexual abuse 8 (see Appendix A). 3.2 All referrals to a Child Protection Agency or police service must be documented on the health record including what was suspected, witnessed and/or reported. 4 The Child and Family Services Act, Chapter C-7 s.81(1) 5 The Emergency Protection for Victims of Child Sexual Abuse and Exploitation C-E-8.2 s.(3) 6 The Child and Family Services Act, Saskatchewan, Chapter C-7.2 s.12(1) 7 The Child and Family Services Act, Chapter C-7.2 s.12(1) 8 The Emergency Protection for Victims of Child Sexual Abuse and Exploitation C-E-8.2 s.4(1) Page 2 of 13
3.3 All Apprehensions conducted within an SHR facility or community setting where SHR services are provided by SHR Staff must be documented. 3.4 In instances where Staff become aware of suspected child abuse that has not been reported to the MSS, Staff must report this as a safety incident, by contacting 306-655-1600 or 1-844-655-1600. 4. ROLES AND RESPONSIBILITIES 4.1 All Staff 4.1.1 In situations where Child Abuse is suspected, provide unbiased support to the patient and family. 4.1.2 Report and document all instances of suspected child abuse/ sexual abuse and apprehensions (see procedure). 4.1.3 Staff are not responsible for further investigation. The MSS has the full responsibility to investigate reports of suspected child abuse/ sexual abuse. 4.1.5 If uncertain as to the legal requirements and obligations related to reporting suspected child abuse/child sexual abuse consult SHR Social Work, the Manager or designate. The MSS may be consulted prior to reporting. 5. POLICY MANAGEMENT The management of this policy including policy education, monitoring, implementation and amendment is the responsibility of the Director, Interprofessional Practice, Education and Research. 6. NON-COMPLIANCE/BREACH Non-compliance with this policy may result in disciplinary action up to and including termination of employment and/or privileges. A failure to report may be reported to police services. The Ministry of Justice may charge an individual with an offence under The Child and Family Services Act, Saskatchewan or The Emergency Protection for Victims of Child Sexual Abuse and Exploitation Act, Saskatchewan and may be subject to summary conviction, possible fine or imprisonment. 9 9 The Child and Family Services Act 81(2)(e)(f) Page 3 of 13
PROCEDURE Number: 7311-50-007 Title: SUSPECTED CHILD ABUSE Authorization [ ] President and CEO [X ] Vice President, Finance and Corporate Services Source: Director, Interprofessional Practice, Education and Research Cross Index: 7311-75-009 Date Approved: June 12, 2012 Date Revised: May 19, 2016 Date Effective: June 27, 2016 Date Reaffirmed: Scope: SHR 1. PURPOSE The purpose of this procedure is to establish the process for SHR Staff when faced with situations involving suspected child abuse and/or suspected child sexual abuse. This procedure also provides guidance to SHR Staff when advised by the MSS that an Apprehension will take place in an SHR facility or service. 2. PRINCIPLES 2.1 While SHR Staff maintain confidentiality in their work, children s health and safety are paramount. Duty to report suspected child abuse overrides any duty to protect the privacy of clients or patients. 10 2.2 Staff do not need to establish a diagnosis of Child Abuse for a report to be made. 3. PROCEDURE Suspected Child Abuse 3.1 Provide medical care as required and document findings on the health record. assess, diagnose and treat any condition associated with Child Abuse, inclusive of referrals for any subsequent medical care, counseling, treatment or support; preserve the physical and emotional well-being of the child being examined; gather and preserve medical evidence. 3.2 For guidance regarding any aspect of this process contact a SHR Social Worker, your Manager or designate for consultation, guidance and support if needed. 3.2.1 Contact SHR Security Services or police services if there is any immediate risk or safety concern for any individual. 10 Saskatchewan Child Abuse Protocol, 2014 Page 4 of 13
3.3 Report the case immediately to a child protection worker in the MSS or if after regular business hours, report to Mobile Crisis (see Appendix B for contact information). The MSS will triage as appropriate for rural communities and First Nations. 3.3.1 The duty to report cannot be delegated. 3.3.2 Each healthcare provider is required to report suspected child abuse whether or not other healthcare providers are in agreement (see Appendix B for contact information). 3.3.3 If the patient is being seen by a number of different care providers, the health care team must determine who will report the suspected child abuse to a Child Protection Agency/police services. 3.3.4 Parental or caregiver consent is not required prior to a report being made. Don t be afraid to make a report based on your gut feeling when you do not have hard evidence. It is your duty to report and MSS s role to decide whether or not to investigate. Don t question the child about the alleged abuse as this could taint the evidence. Don t stop the child/caregiver from disclosing and talking about the abuse; just listen and write down what the child/ caregiver said in quotation marks. Contact a SHR Social Worker or your immediate supervisor for consultation, guidance and support if needed. 3.3.5 If unsure whether there are sufficient grounds for reporting Child Abuse discuss with a MSS child protection worker. 3.3.5.1 Call the MSS reporting number (see Appendix B). 3.3.5.2 Describe the situation to the MSS child protection worker without providing identifying information of the family. 3.3.5.3 Ask the MSS child protection worker if this situation needs to be reported. 3.3.5.4 Follow the instructions of the MSS child protection worker including providing identifying information if a report is needed. 3.3.6 If neither the child or caregiver are a patient in a suspected child abuse situation (i.e. a visitor/guest of the patient): Report to a Child Protection Agency or police service (see Appendix B). Contact the Safety Alert Line (306-655-1600 or 1-844-655-1600). This ensures documentation that a report was made and the information will be available to the MSS and/or police if needed. 3.3.7 Document all pertinent information that caused your suspicion. Volunteered statements/disclosures etc. in quotation marks. Document the date and time of your report in the health record and the name of the child protection worker you gave the report to (as a record of having fulfilled your legally mandated obligation). If you do not have charting privileges, speak to your Manager/Supervisor and/or the charge nurse if you made a report regarding a patient, so they can document you having fulfilled your legally mandated obligation. Page 5 of 13
3.4 Share information regarding the child s needs as required throughout the investigation, assessment and treatment of the child and the child s family. 3.5 Co-operate with the child protection worker and police by providing information regarding the physical, psychological and behavioral indicators of the reported abuse. 3.6 Provide support to the child and family during and after the child abuse investigation. 3.7 Provide physical and mental health treatment and consultation to victims and perpetrators of Child Abuse and their families. 3.8 Provide medical evidence, documentation and expert opinion in court proceedings. 11 3.8.1 The nature of the situation determines what medical evidence would be needed. This is determined by the healthcare provider. Apprehensions within an SHR Facility/Service Environment When SHR Staff is advised by the MSS that an Apprehension will take place in their employment environment (unit/department/sector/community setting) Staff: 3.9 Advise SHR Social Work, in SHR settings where there is an assigned Social Worker. 3.10 Provide a secure, private space for the Apprehension to occur (i.e. not in a ward). 3.10.1 If Security Services are available, request security presence. 3.10.2 If Security Services are not available and the situation is determined to be of high risk to the safety of the child, Staff and/or other patients, local police presence may be requested. 3.11 Obtain a copy of the Apprehension Order and attach to the health record on the right hand side. 3.11.1 The MSS child protection worker s name is on the Apprehension Order. 3.11.2 The apprehending MSS child protection worker will inform SHR Staff regarding who is responsible for the child and who is responsible for making healthcare decisions. Release of Information to the Ministry of Social Services or Police 3.12 If the report is initiated by SHR Staff, Staff will provide information regarding the child as requested by the child protection worker/police services. 3.12.1 If further information is required after the initial report has been made, MSS complete Appendix C, police services complete Appendix E. 3.12.1.1 Direct Appendix C or E to Health Records. 3.12.1.2 Questions related to release of information should be directed to the Privacy and Access Department. 11 Saskatchewan Child Abuse Protocol, 2014 Page 6 of 13
3.13 When the MSS or the police services are investigating a report of Child Abuse that was not initiated by SHR staff, police services or MSS must complete and provide a written request for information (see Appendix C, D or E). 3.13.1 Questions related to release of information should be directed to the Privacy and Access Department. 3.13.2 Direct Appendix C and D to Health Records. 3.13.3 Direct Appendix E to the Privacy and Access Department. 4. PROCEDURE MANAGEMENT The management of this procedure including procedure education, monitoring, implementation and amendment is the responsibility of the Director, Interprofessional Practice, Education and Research. 5. NON-COMPLIANCE/BREACH Non-compliance with this procedure may result in disciplinary action up to and including termination of employment and/or privileges. 6. REFERENCES Child Abuse and Neglect Policy, Horizon Health Network Policy and Procedure Manual, 2013 Criminal Code, Canada The Child and Family Services Act, Saskatchewan The Emergency Protection for Victims of Child Sexual Abuse and Exploitation Act, Saskatchewan Saskatchewan Child Abuse Protocol, Government of Saskatchewan, 2014 Page 7 of 13
APPENDIX A Child means under the age of 16 years of age under The Child and Family Services Act and under 18 years of age for The Emergency Protection for Victims of Child Sexual Abuse and Exploitation Act. Suspected child abuse/neglect is reportable where, as a result of action or omission by the child s parent: 1. The child has suffered or is likely to suffer physical harm; 2. The child has suffered or is likely to suffer a serious impairment of mental or emotional functioning; 3. The child has been or is likely to be exposed to harmful interaction for a sexual purpose, including involvement in prostitution and including conduct that may amount to an offence within the meaning of the Criminal Code; 4. Medical, surgical or other recognized remedial care or treatment that is considered essential by a duly qualified medical practitioner has not been or is not likely to be provided to the child; 5. The child s development is likely to be seriously impaired by failure to remedy a mental, emotional or developmental condition; or 6. The child has been exposed to domestic violence or severe domestic disharmony that is likely to result in physical or emotional harm to the child; 7. There is no adult person who is able and willing to provide for the child s needs, and physical or emotional harm to the child has occurred or is likely to occur; 8. The child is less than 12 years of age and there are reasonable and probable grounds to believe that: 8.1 The child has committed an act that, if the child were 12 years of age or more, would constitute an offence under the Criminal Code, the Narcotic Control Act (Canada) or Part III or Part IV of the Food and Drug Act (Canada); and 8.2 Family services are necessary to prevent a recurrence; and 8.3 The child s parent is unable or unwilling to provide for the child s needs. 12 Suspected Child Sexual Abuse is Reportable Where: A child has been subjected to sexual abuse if the child has been, or is likely to be, exposed to harmful interaction for a sexual purpose, including involvement in prostitution and involvement in conduct that may amount to an offence pursuant to the Criminal Code. 13 12 The Child and Family Services Act, Chapter C-7.2 s.11 13 The Emergency Protection for Victims of Child Sexual Abuse and Exploitation C-E-8.2 s.3 Page 8 of 13
APPENDIX B Contact Information to report Suspected Child Abuse (SHR Urban and Rural) Ministry of Social Services Child and Family Program Monday Friday 8:00am 5:00 pm Contact the MSS region where the child lives. Saskatoon (Center Region) 306-933-6077. Toll free number: 1-800-274-8297 PA (North Region) 306-953-2422 Regina (South Region) 306-787-3800 The MSS child protection intake worker will either take your report or give you the number of the agency to contact. After Hours, Evening/Weekends/Statutory Holidays: Mobile Crisis - 306-933-6200 Page 9 of 13
Page 10 of 13 APPENDIX C
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Page 12 of 13 APPENDIX D
Page 13 of 13 APPENDIX E