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3.5 Section 47 Enquiry

AMENDMENT

In March 2017, this chapter was updated and now includes a link to Medical Form E&N Herts and Immediate Form for Child Protection Examination West Herts Trust.


Contents

  1. Duty to Conduct Section 47 Enquiries
  2. Threshold for Section 47 Enquiries
  3. Role of Assessment Team / Allocated Social Worker in Section 47 Enquiries
  4. Single and Joint Agency Investigations
  5. Immediate Protection
  6. Involving Parents, Family Members and Children
  7. Meeting the Child
  8. Inability to Access the Child
  9. Medical Assessment
  10. Consent for Medical Assessments
  11. Arranging Medical Assessments
  12. Recording of Medical Assessment
  13. Analysis and Assessment of Risk
  14. Professional Disagreement at Enquiry Stage
  15. Outcome of Section 47 Enquiries
  16. Recording of Section 47 Enquiries
  17. Timescales
  18. Children Services’ process to ensure ICPCs are held within 15 working days of the Strategy Discussion/Meeting where the Decision was taken to commence a Section 47 Enquiry


1. Duty to Conduct Section 47 Enquiries

Obligations and Responsibilities of all Agencies:

All agencies have a professional (and in most cases statutory) duty to assist and provide information in support of child protection enquiries (Section 47 Enquiries).

Responsibility of Children's Services

Children's Services has the:

  • General duty to safeguard and promote children's welfare (Section 17 Children Act 1989);
  • Duty to make, or cause to be made, enquiries when the circumstances defined in Section 47 of the Children Act 1989 exist;
  • Responsibility to inform Police in a case referred which constitutes or may constitute a criminal offence against a child.

Responsibility for undertaking Section 47 Enquiries lies with the local authority in which the child lives or is found (see Children Moving Across Local Authority Boundaries Procedure).

When the child's home address is in another (the 'home') authority, the 'host' authority (i.e. the authority where the alleged abuse and/or neglect is said to have occurred) has responsibility for undertaking enquiries e.g. alleged abuse on a school trip out of the authority.

In this case, the child's 'home' authority should be informed as soon as possible and involved in Strategy Discussions. It will often be appropriate for the 'home'

Authority to undertake the necessary enquiries on behalf of the host authority e.g. in the case of a looked after child or a child allegedly abused or neglected whilst in 'host' authority but since returned to 'home' authority.

The home authority should take responsibility for further support of the child or family, following the Section 47 Enquiry.

Responsibility of Police

Police have a responsibility to:

  • Investigate allegations of criminal offences against children;
  • Refer any suspicion, allegation or disclosure a child is suffering or likely to suffer significant harm to Children's Services.

When allegations arise in relation to the child's circumstances within a host authority, the home Police Joint Child Protection Investigation Team (JCPIT) retains responsibility but may negotiate with their colleagues in the host area.


2. Threshold for Section 47 Enquiries

Section 47 Enquiries start when:

  • There is reasonable cause to suspect that a child who lives in or is found in, a local authority area is suffering or likely to suffer significant harm in the form of physical, sexual, emotional abuse or neglect;
  • Following an Emergency Protection Order or use of Police Powers of Protection (PPOP).

Note: Where a sibling group is already the subject of a child protection plan and it is established that the mother is pregnant, a Strategy discussion and S47 enquiries must be completed in respect of the unborn baby, prior to presentation at an Initial Child Protection Conference (which may be the Review Child Protection Conference for the siblings).

Children's Services is the lead agency for child protection enquiries. The Police are the lead agency for any associated criminal investigation.

Children's Services must consult the Police Joint Child Protection Investigation Team (JCPIT) and other agencies involved with the child, so that relevant information can be taken into account (see Information Sharing and Confidentiality Procedure).

Section 47 Enquiry Intervention Threshold

The Team Manager has the responsibility, on the basis of available information, to decide and authorise a Section 47 Enquiry. In undertaking the necessary assessment of risk, the manager must consider both the probability of the event or concern in question and its actual or likely consequence.

In reaching her/his conclusion as to the justification for a Section 47 Enquiry, the manager must consider the following variables:

  • Seriousness of the concern(s);
  • Combinations of concerns;
  • Repetition or duration of concern(s);
  • Vulnerability of child (through age, developmental stage, disability or other pre-disposing factor e.g. whether they are 'Looked After');
  • Source of concern(s);
  • Accumulation of sufficient information;
  • A child in the carer's current or previous household is / has been the subject of a Child Protection Plan or of previous Care Proceedings;
  • There has been a previous unexpected death of a child whilst in the care of either parent where abuse /neglect is/was suspected;
  • Emotional environment of child, especially high criticism / low warmth;
  • Any predisposing factors in the family that may suggest a higher level of risk e.g. domestic abuse, substance misuse and/or mental health issues;
  • The impact on the child's health and development.

A Section 47 Enquiry must always be commenced immediately if there is a disclosure, allegation or evidence that a child is suffering or likely to suffer significant harm. This applies equally to new, re-referred and open cases.

Click here to view the Continuum of Needs.

A combination of any factors which individually would require only an Assessment, when combined with parental risk factors e.g. domestic violence, parental mental illness, excessive drinking or drug use, may justify considering Section 47 Enquiries.


3. Role of Assessment Team/Allocated Social Worker in Section 47 Enquiries

Enquiries must be undertaken by a suitably qualified social worker, either in the assessment team or the allocated social worker on an open case.

The duty / social worker must (as per child protection enquiry screen):

  • Obtain clear, detailed information about the concerns, suspicion or allegation;
  • Obtain history and background information including agency files and previous addresses of the child and anyone relevant to his/her situation. This includes fathers or partners of mothers who may not reside with mother and may be registered with a different GP Practice to the mother. A check with the GP should include drug and alcohol use, and the Spectrum (Crime Reduction Initiative) as to whether there is any involvement with father or partner by the agencies.
  • Establish if the child, any other children in the household or children who have previously lived with the caregiver(s) have ever been subject to a child protection plan;
  • Establish whether the child has ever been subject to a Common Assessment (CAF);
  • Report to the responsible manager;
  • Take any necessary immediate action;
  • Contact the local Police Joint Child Protection Investigation Team (JCPIT) if at any point it is suspected that a crime may have been committed;
  • Convene a Strategy Discussion/Meeting;
  • Agree with manager if parental agreement to be sought prior to undertaking agency checks, recording the decision;
  • Undertake agency checks with agencies that may be involved with the child and family;
  • Undertake checking of ID of all children and their carers, i.e. passport, birth certificate, marriage certificate etc. (see Safeguarding Children from Abroad, Section 6 Establishing the Child's Identity and Age)


4. Single and Joint Agency Investigations

Police and Children's Services Liaison

Although the primary responsibility of Joint Child Protection Investigation Team (JCPIT) staff is to undertake criminal investigations of suspected, alleged or actual crime, the absence of a criminal prosecution does not mean the absence of abuse. Children's Services has the statutory duty to make, or cause to be made, enquiries when circumstances defined in Section 47 of the Children Act 1989, exist.

Criminal investigations and Section 47 Enquiries may give rise to circumstances and information relevant to decisions that have to be taken by both agencies. Consideration must always be given to information gathered about the home, community and work circumstances of those suspected of having abused or neglected a child in the event that they are/have been in contact with other children.

Children's Services and Joint Child Protection Investigation Team (JCPIT) / Area Crime Unit must inform each other of any allegations or suspicions of abuse or neglect, including 'stranger abuse' in line with Information Sharing and Confidentiality Procedure. Line managers should be consulted in cases of uncertainty and advice recorded.

A joint decision should be made about the appropriate level of intervention and of Police involvement throughout the process, depending on the individual circumstances and context.

If initial allegations are imprecise or concerns arise gradually, it may be agreed that Children's Services undertake further assessment to determine if a child has suffered, or is likely to suffer, significant harm.

Where both agencies have responsibilities with respect to a child, they must co-operate to ensure the joint investigation (combining the parallel processes of a Section 47 Enquiry and a criminal investigation) is undertaken in the best interests of the child. This should be achieved primarily by co-ordination at Strategy Discussions and/or meetings.

If the agencies agree that a single agency enquiry or investigation is appropriate, there should still be an exchange of relevant information, involvement in Strategy Discussions and agreement reached as to the feedback required by the non participating agency. A case may start as single agency, but further assessment / information indicate the need for joint investigation. As the decision is made the Team Manager must ensure that appropriate checks are undertaken, always including health checks.

Any decision to terminate enquiries or investigations must be communicated to the other agency for it to consider, and the rationale recorded by both agencies.

The decision regarding single or joint agency investigations should be taken at a Strategy Discussion and authorised by first line managers in the Police (Joint Child Protection Investigation Team (JCPIT)) and Children's Services.

Joint Agency Investigation:

A joint investigation must always be initiated when there is an allegation or reasonable suspicion that one of the circumstances described below exists regardless of the likelihood of a prosecution:

  • A sexual offence against a child of either gender under eighteen years of age, including sexual offences committed by children, but excluding 'stranger abuse';
  • Physical injury which could be considered serious by the extent of the injury, age of child or by repeated assaults of a minor injury (this category includes murder; manslaughter; violence to a child constituting an assault, actual or grievous bodily harm; bruising and soft tissue injuries to babies; repeated assaults causing minor injury; burns and scalds);
  • All non accidental injuries to children aged under 2 years;
  • Serious neglect or ill-treatment constituting an offence under s.1 Children and Young Persons Act 1933;
  • Complex investigations;
  • Unexpected death of a child;
  • Fabricated or Induced Illness Procedure;
  • Allegations Against Adults who Work with Children and Young People Procedure e.g. staff of a professional agency represented on the LSCB, day care registered with Ofsted, baby sitters, voluntary group leader / helper (must also be reported to senior managers in Children's Services and Joint Child Protection Investigation Team (JCPIT)).

Cases of minor injury should always be considered for a joint enquiry / investigation if the child is:

  • Subject of a Child Protection Plan;
  • Looked after by the local authority.

If information is received to indicate a person who has been identified as being a risk to children is living in or has access to a household where there are children, Children's Services and Joint Child Protection Investigation Team (JCPIT) must discuss the circumstances and agree if a single enquiry or joint investigation should be initiated.

In other cases of minor injury, the circumstances must be considered to determine 'seriousness' and the following factors should be included in Joint Child Protection Investigation Team (JCPIT) and Children's Services consideration:

  • Age, special needs and vulnerability of the child;
  • Previous history of minor injuries to child / others in household;
  • 'Intention' e.g. strangulation may leave no marks, but is very serious;
  • Whether a weapon or implement was used;
  • Previous concerns from a caring agency;
  • Consistency with, and clarity / credibility of child's account of injuries;
  • Predisposing factors about alleged perpetrator e.g. conviction(s), history of violence, substance misuse and/or mental health problems;
  • A history of domestic violence and conflict around Contact arrangements;
  • Presence of unusual circumstances e.g. suspected complex abuse or fabricated and induced illness;
  • Child's wish (if age appropriate) for Police involvement.

There will be times that after discussion, or preliminary work, cases will be judged less serious and it will be agreed that the best interests of the child are served by a Children's Services led intervention, rather than a joint investigation.

In all cases the welfare of the child remains paramount and always takes precedence over the need to commence or conclude any criminal investigation.

Children's Services Single Agency Investigation

When, after making relevant checks, the Team Manager in Children's Services and the Joint Child Protection Investigation Team (JCPIT) assess that the circumstances of the case do not indicate that a crime has been committed, Children's Services may progress single agency enquiries. The absence of a criminal prosecution does not mean the absence of abuse.

Where the case is subsequently discovered to be more serious than originally perceived, it must be referred back to the Joint Child Protection Investigation Team (JCPIT).

Examples of circumstances that may be appropriate for Children's Services single agency enquiry are:

  • Purely emotional abuse with no apparent physical symptoms, unless extreme circumstances constitute an offence of cruelty;
  • Minor physical injury caused to a child in circumstances amounting to poor parenting but bearing in mind the points about minor injuries in the Section 5, Joint Investigations;
  • Minor physical abuse, except for injuries to infants (under the age of 2 years) see above section Joint Agency Investigation: no visible injury or minor injury; the child provides a coherent account of how the non-accidental injury occurred and there was no intent to injure her/him; where there has been no previous allegations regarding that child or the alleged perpetrator;
  • Minor allegations of physical abuse against professionals responsible for the care of a child e.g. teacher, where an allegation may represent inappropriate behaviour as opposed to criminal behaviour (Joint Child Protection Investigation Team (JCPIT) and the Designated Officer should be consulted before and after Children's Services single agency enquiry and joint decision made about subsequent Police action) see Managing Allegations Against Adults Procedure;
  • Minor neglect through inappropriate supervision or poor parenting skills. Minor neglect is established following an Assessment;
  • Indirect suspicions of sexual abuse, including over-sexualised behaviour of a child, anonymous reports and concerns by other professionals;
  • An assessment is required to establish significant harm or the likelihood of significant harm which will inform the future plan.

Where a minor crime, initially agreed by Joint Child Protection Investigation Team (JCPIT) as inappropriate of further Police investigation, is subsequently discovered to be more serious, the case must be referred back to the Joint Child Protection Investigation Team (JCPIT).

Police Single Agency Investigation

Criteria for Police single agency investigations are those where:

Where the Police conduct, out of hours, a single agency investigation, (in response to a duty to respond and take action to protect the child or obtain evidence), Children's Services EDT must be informed immediately, and if appropriate, a joint investigation commenced.

In all cases where the Police undertake a single agency child protection investigation, details of any victim aged under eighteen must be referred to Children's Services, which is responsible for assessing if the investigation raises any child protection issues and if supportive or therapeutic services are appropriate.

Where Police are investigating a crime that may cause concern for non-specific children e.g. person in possession of child abuse images, Police must undertake enquiries as to any contact that person may have with children: this includes personal, social, volunteer and work related contact.

Dispute Resolution

Further discussion should occur between the line managers (detective sergeant / inspector and Children's Services Team Manager) if there is any disagreement between agencies about the:

  • Need for a joint investigation or the 'seriousness' of alleged physical abuse;
  • Possibility that the needs of the criminal investigation, conflict with the needs of a child.

If line managers disagree, the matter should be referred to the responsible detective inspector and Head of Child Protection, Children’s Services see also Escalation of Concerns and Professional Disagreements About Decisions, Including Convening an ICPC Procedure.


5. Immediate Protection

If there is a risk to the life of a child or a likelihood of serious immediate harm, an agency with statutory child protection powers (as defined by the Children Act 1989) must act quickly to secure the immediate safety of the child.

Emergency action may be necessary as soon as a referral is received or at any point of involvement with child(ren), parents or carers.

Responsibility for immediate action rests with the authority where the child is found in consultation with any 'home' authority e.g. if looked after or subject to a Child Protection Plan in another local authority.

Only if the 'home' authority is prepared to accept explicit responsibility is the host authority absolved of the responsibility to take action. This must be confirmed in writing immediately by fax or e-mail.

Immediate protection may be achieved by:

  • An alleged abuser agreeing to leave the home;
  • Removal of the alleged abuser;
  • Voluntary agreement for the child(ren) to move to, or remain in, a safer place with / without a protective person e.g. friend, hospital;
  • Application for an Emergency Protection Order EPO;
  • Removal of the child(ren) under Police Protection;
  • Gaining entry to the household under Police Powers.

The social worker must seek the agreement of her/his Team Manager and obtain legal advice before initiating legal action. If a Legal Planning Meeting is held the Group Manager must chair it.

Children's Services should only seek Police assistance to use their powers in exceptional circumstances where there is insufficient time to seek an EPO or other reasons relating to the child's immediate safety.

The agency taking protective action must always consider whether action is also required to safeguard other children in the same household, in the household of an alleged perpetrator or elsewhere.

Where there has been an unexpected (unexplained) child death (See Learning and Improvement Framework Procedure) consideration may need to be given to the safety of other siblings / children in the home.

Planned immediate protection should normally be initiated following a strategy discussion (See Strategy Discussion and Meetings Procedure).

When an agency has to act to protect a child prior to a Strategy Discussion, a Strategy Discussion should be undertaken by the Children's Services Team Manager immediately, or at the latest within one working day of the action, to plan the next steps.

The need for a Legal Planning meeting should also be considered.


6. Involving Parents, Family Members and Children

The social worker has the prime responsibility to engage with family members in order to assess the overall capacity of the family to safeguard the child, as well as ascertain the facts of the situation causing concern. Where abuse is alleged, the initial response by professionals should be limited to listening carefully to what the child says so as to:

  • Clarify the concerns;
  • Offer re-assurance about how (s)he will be kept safe; and
  • Explain what action will be taken.

The child must not be pressed for information, led, cross-examined or given false assurances of absolute confidentiality. Such well intentioned actions could prejudice Police investigations, especially in cases of sexual abuse.

Where a criminal investigation is ongoing this should be done in consultation with the police officer in the case.

Parents and those with Parental Responsibility must be informed at the earliest opportunity of concerns, unless to do so would place the child at an increased likelihood of suffering significant harm, or undermine a criminal investigation.

Parents and children (where appropriate) should, in addition to being offered a verbal explanation of the child protection enquiry process, be provided with explanatory leaflet(s).

Due consideration must be given to parent(s)' capacity to understand this information in a situation of significant anxiety and stress.

Consideration must be given to those for whom English is not their first language or who may have a physical / sensory / learning disability and may need the services of an appropriate interpreter. See Interpreters, Signers and Others with Special Communication Skills Procedure.

It is also essential that factors such as race, culture, religion, gender and sexuality together with issues arising from disability and health are taken into account. It may also be necessary to provide information in stages and this must be taken into account in planning the enquiry (for parents with learning disabilities see Children with Parents with Learning Disabilities Procedure).

In planning any intervention with parent(s), the following points must be covered:

  • An explanation given of the reason for concern and where appropriate the source of information;
  • The procedures to be followed (including an explanation of the need for the child to be seen, interviewed and/or medically examined and seeking parental agreement for these aspects of the enquiry and/or investigation);
  • An explanation of their rights as parents including the need for support and guidance from an advocate whom they trust (advice should be given about the right to seek legal advice);
  • An explanation of the role of the various agencies involved in the enquiry / investigation and of the wish to work in partnership with them to secure the welfare of their child;
  • The need to gather initial information on history and structure of the family, the child and other relevant information to enable an assessment of the injuries and/or allegations and the continuing risk to the child to be made;
  • In situations of domestic abuse, the possibility of working with the parents separately;
  • Assessment of evidential opportunities in a Police investigation and recovery of evidence that may confirm or refute an allegation or suspicion of crime;
  • The provision of an opportunity for parents to be able to ask questions and receive support and guidance.

In the event of any conflict between the needs and wishes of the parents and those of the child, the child's welfare is the paramount consideration in any decision or action.

Recognising that there may be alternative accounts and disparities, parents should be provided with an early opportunity to explain their perception of the concerns.

In the course of an enquiry it may be necessary for statutory agencies to make decisions or initiate actions to protect children, or require the parents to agree to such action.

The social worker must inform relevant agencies of any such decisions or actions and confirm them in writing without delay.


7. Meeting the Child

All children within the household must be directly communicated with during an enquiry (unless the Strategy Discussion decides this is not appropriate). Those who are the focus of concern must be seen alone, subject to age and preferably with parental permission.

Exceptionally, a joint enquiry / investigation team may need to speak to a suspected child victim without the knowledge of parent / caregiver. Relevant circumstances include:

  • The possibility a child would be threatened or otherwise coerced into silence;
  • A strong likelihood that important evidence would be destroyed; or
  • That the child in question did not wish the parent to be involved at that stage, and is competent to take that decision.

Note: Section 47 Enquiries should always involve interviews with the child who is the subject of concern. The child should be seen by the lead social worker and communicated with alone when appropriate. Some children may need to be seen, for example, with an interpreter or a person who can use their preferred method of communication Others, such as babies, may need to be seen in the presence of their primary caregiver so as to minimise their distress and observe their interactions.

Timing

The Strategy Discussion must decide where, when and how child(ren) should be seen and whether an investigative interview is required (See Strategy Discussion and Meetings Procedure).

The child must be seen on the day of referral (unless the Strategy Discussion decides and records a decision to defer this) if:

  • Allegations / concerns indicating a serious risk e.g. serious physical injury, injury to a baby, serious neglect or other severe health risk;
  • (S)he is reported to have sustained a physical injury;
  • (S)he has disclosed sexual abuse and is to be returned to a situation that might place him/her at risk or to ensure forensic evidence;
  • (S)he is already the subject of a Child Protection Plan;
  • (S)he is abandoned;
  • (S)he is frightened to return home.

Issues to Consider

Consideration must be given to child's developmental stage and cognitive ability. Specialist help may be needed if:

If the child is unable to take part in an interview because of age or understanding, alternative means of understanding should be used e.g. observation of very young children.

Consideration should be given to the gender of interviewers, particularly in cases of alleged sexual abuse and it is also essential factors such as race, culture, religion, gender and sexuality together with issues arising from disability and health are taken into account.

Children may need time, and more than one opportunity to develop trust and communicate concerns, especially if they are very young or have a communication impairment, learning disability or mental health problems.

Objectives

The objectives in seeing the child are to:

  • Hear her/his account of allegations or concerns and whether these constitute a criminal offence;
  • Record and evaluate, demeanour, mood state and behaviour;
  • Observe and record the interactions of child and carers;
  • See and record the circumstances in which the child is currently living and sleeping and, if different, her/his ordinary residence;
  • Evaluate the physical safety of the environment including the storage of hazardous substances e.g. bleach, drugs;
  • Ensure that any other children who need to be seen are identified;
  • Assess the degree of risk and possible need for protective action;
  • Meet the child's needs for information and re-assurance;
  • Assess the child's willingness to pursue the complaint through the Police;
  • Make decisions about format to be used if a detailed account to be given by the child;
  • Inform decisions about possible medical and forensic needs.

Investigative Interviews

The conduct of and criteria for visually recorded interviews with children are laid out in Achieving Best Evidence in Criminal Proceedings: Guidance on Interviewing Victims and Witnesses and Using Special Measures (Ministry of Justice March 2011) and should be undertaken by those with specialist training and experience in interviewing children.

Para 2.50 of the above guidance indicates that interviewers may often decide the needs of the child and the needs of criminal justice are best served by an assessment of the child prior to the interview taking place, particularly if the child has not had previous or current involvement with Children's Services or other public services.

Where the abuse has involved the use of recording, photography, taking film or videos consideration should be given to how to interview the child without the use of video recording, if the child finds it distressing.

Para. 2.52 of the ABE Guidance indicate interviewers should have clear objectives for assessment(s) prior to interview (There are ABE suits at Peace Children's Centre Watford and the Lister Hospital) and should apply this guidance in talking with children during such assessment, e.g.:

  • Avoid discussing (in any detail) substantive issues;
  • Do not lead the child in substantive matters;
  • Never stop a child who is freely recalling significant events.

As described in the ABE Guidance, interviewers must make a full written record of discussions, noting timing and personnel present as well as what was said and in what order.


8. Inability to Access the Child

Child's Whereabouts Unknown

Children's Services should make all reasonable efforts to persuade parents to co-operate with a Section 47 Enquiry. If a child's whereabouts are unknown, or (s)he cannot be traced by the social worker within twenty four hours the following actions must be undertaken:

  • A Strategy Discussion held with the Police Joint Child Protection Investigation Team (JCPIT) and other agencies;
  • Agreement reached with the manager responsible about further action to locate and access the child and complete the enquiry.

If efforts to locate the child have been unsuccessful within 48 hours, Children's Services must call an urgent Strategy Meeting, involving the Police Joint Child Protection Investigation Team (JCPIT) and any other directly relevant agency. This meeting must consider:

Access to Child Refused / Obstructed

If access to a child is refused or obstructed by parents or caregivers, the social worker must inform the service manager who must, in consultation with her/his manager, have a Strategy Discussion with the Police (if joint investigation) and seek legal advice as appropriate about the need for a Child Assessment Order (where concerns are not so urgent as to require an EPO) or an Emergency Protection Order.


9. Medical Assessment

Urgent Need for Treatment

Where the child appears in urgent need of medical attention (s)he should be taken to the nearest A & E department, regardless of age, explanation or any other factors e.g. where there are suspected fractures, bleeding, and loss of consciousness.

Referrals for Medical Assessment by Children's Services/ Police Joint Child Protection Investigation Team (JCPIT)

In other circumstances the Strategy Discussion should determine, in consultation with the Paediatrician (3.6 Participants to Strategy Discussion) the need for and timing of a paediatric assessment and who would be the appropriate person to accompany the child.

When such arrangements are necessary, the child and those with parental responsibility must be informed and prepared and careful consideration given to the impact on the child, unless there is good reason not to involve the parent or carer, e.g. preservation of criminal evidence - such decisions should be recorded.

If the Strategy Discussion (at which the doctor is consulted) agrees on a paediatric assessment for a child, consideration should be given to the need for assessments of other children in the household.

This assessment should always be considered when there is a suspicion or disclosure of child abuse involving:

  • Any injuries to a baby / non mobile child;
  • A suspicious or serious injury (thought to be non-accidental or an inconsistent explanation);
  • Any injury or a mark on a child who is subject to a Child Protection Plan, and for which there is no obvious explanation;
  • Suspected sexual abuse or assault;
  • Suspected neglect.

A medical assessment involves a holistic approach and considers:

  • The child's well being, including development, if under five years old and her/his cognitive ability if older;
  • The extent of any injuries and an opinion as to possible causes;
  • Diagnosis and treatment;
  • Information provided by other agencies that is known about the child's family circumstances and history, past medical history and full referral information.

Additional considerations are the need to:

  • Secure forensic evidence including photographic evidence;
  • Screen for or investigate medical problems e.g. infection (including sexually transmitted infection), anaemia;
  • Provide treatment follow up and review for the child (any injury, infection, new symptoms including psychological, contraception);
  • Create medical documentation;
  • Provide re-assurance for the child and parent;
  • Provide professional advice to Children's Services and the Police.

An explicit record must be made of the decision about whether or not to undertake a medical assessment, and its rationale clearly stated.

Only doctors may physically examine the whole child using standard forms to document the assessment. Other professional staff should note any visible marks or injuries on the body map and document details in their recording.

Please also see Recognition of Child Abuse 5th Edition for description of forensic medical examination for child sexual abuse.


10. Consent for Medical Assessments

The paediatrician is responsible for obtaining informed consent. The doctor must personally (i.e. by direct face to face contact) obtain signed consent in order to be able to do the assessment.

The following may give consent to a medical assessment:

  • A child of sufficient age and understanding (as per Fraser guidelines);
  • Any person with parental responsibility;
  • The local authority when the child is the subject of a care order (though the parent/carer should be informed by the Children's Services social worker;
  • The local authority when the child is accommodated under Section 20 Children Act 1989, and the parent / carers have abandoned the child or are physically or mentally unable to give such authority;
  • The High Court when the child is a Ward of Court;
  • A Family Proceedings Court as part of a direction attached to an Emergency Protection Order, an Interim Care Order or a Child Assessment Order.

When a child is looked after under Section 20 and a parent / carer has given general consent authorising medical treatment for the child, legal advice must be taken about whether this provides consent for paediatric assessment for child protection purposes (the parent / carer still has full Parental Responsibility for the child)

A child of any age who has sufficient understanding (generally to be assessed by the doctor with advice from others as required) to make a fully informed decision can provide lawful consent to all or part of a paediatric assessment or emergency treatment.

A young person aged sixteen or seventeen has an explicit right (Section 8 Family Law Reform Act 1969) to provide consent to surgical, medical or dental treatment and unless grounds exist for doubting her/his mental health, no further consent is required.

A child who is of sufficient age and understanding may refuse some or all of the paediatric assessment though a court can potentially override refusal, but be aware an examination cannot be forced onto any child.

Whenever possible the permission of a parent should be sought for children under sixteen prior to any paediatric assessment and/or other medical treatment.

When circumstances do not allow permission to be obtained and the child needs emergency medical treatment the medical practitioner may:

  • Regard the child to be of an age and level of understanding to give her/his own consent;
  • Decide to proceed without consent.

In these circumstances, parents must be informed as soon as possible and a full record must be made at the time.

In non-emergency situations, when parental permission is not obtained, the social worker and manager must consider whether it is in the child's best interests to seek a court order.


11. Arranging Medical Assessments

The Children's Services social worker or the Police are responsible for arranging medical assessments. Health is responsible for performing the assessments (please note Section 10, Consent for Medical Assessments).

Referrals for child protection medical assessments from a social worker or a member of the Police Joint Child Protection Investigation Team (JCPIT) are made as follows:

  • Contact the local community paediatrician during office hours using local arrangements ( See Contacts);
  • For out of hours contact the hospital switch board.

Medical assessments are the responsibility of the consultant community paediatrician or, if the child is in hospital, the consultant general paediatrician along with the community paediatrician. They may seek further advice from the Named (or Designated) Doctor.

Consideration must be given to holding a meeting pre and post medical examination if this would assist in clarifying reasons for and scope of the assessment.

The referral should be made as early as possible i.e. at the Strategy Discussion.

The paediatrician may arrange to examine the child her/himself, or arrange for the child to be seen by a colleague.

When there is a potential criminal investigation a Police Joint Child Protection Investigation Team (JCPIT) officer should directly brief the doctors, before the medical assessment, and afterwards take possession of evidential items. An FME may collect the specimens.

Child sexual abuse medical assessments should be undertaken in accordance with the guidance for paediatricians and FMEs; Guidelines on Paediatric Forensic Examinations in Relation to Possible Child Sexual Abuse produced by the Royal College of Paediatrics and Child Health and the Association of Forensic Physicians September 2007.

In cases of severe neglect, physical injury or recent (usually within last three days) penetrative sexual abuse, the assessment should be undertaken on the day of referral to Children's Services, where compatible with the welfare of the child. The request should be made as early as possible.

The timing of the medical assessment should be agreed with health at the strategy discussion, taking into account whether the investigative interview should take place before or after the paediatric assessment.

The need for a specialist assessment by a child psychiatrist or psychologist should be considered (see Achieving Best Evidence in Criminal Proceedings: Guidance on Interviewing Victims and Witnesses and Using Special Measures (Ministry of Justice March 2011)).

Suggested Timings of Assessments

The timing of the medical assessment will be dictated by clinical urgency. However, as per the Victoria Climbié recommendations, children brought to the hospital or any health clinic or similar place for a paediatric assessment should be seen within twenty four hours of arrival. There are exceptions when every child needs to be assessed according to the urgency of treatment required and in some cases, require immediate, or fairly urgent, attention.


12. Recording of Medical Assessment

Paediatricians must make contemporaneous notes in the Child Protection Medical Report, from which reports / witness statements will be produced.

The examining doctor must provide a written report of her/his medical opinion, which can be used in a Child Protection Conference and/or subsequent legal proceedings. Witness statements should be produced in the same format used by the Police to avoid the Police re-typing them. The report should be sent to both Children's Services and the Police Joint Child Protection Investigation Team (JCPIT).

In order to help facilitate the progression of decision making around safeguarding children and young people, a summary form has been developed in partnership with East & North Herts Trust and West Herts Trust colleagues. Use of these forms provides a timely evidenced response to child protection concerns of a physical or sexual nature and enables actions to be taken by social workers in considering immediate safeguarding steps for children, as an interim measure before the full report is completed. This form does not replace the full medical report that is still provided following a child protection medical but does provide information on the findings without delay.

The form will be completed by the relevant examining paediatrician and passed to the social worker on completion of the medical (or on the same day) where the information will be utilised as part of the assessment process. The form must be stored within the child / young person’s records.

See also: Medical Form E&N Herts and Immediate Form for Child Protection Examination West Herts Trust.

The full report should still be made available within three working days and usually include:

  • Date, time and place of examination;
  • Those present;
  • Reason for the examination, including referral information Carefully distinguish between fact and opinion;
  • The consent to the examination, whether verbal or written and by whom it was given;
  • A verbatim record of the carer's and child's accounts of injuries and concerns noting any discrepancies or changes of story;
  • A verbatim record of information provided by Police and Children's Services;
  • Documentary findings in both words and diagrams of any injuries or marks including site, size, shape and colour;
  • The findings relevant to the child, including general medical examination and others, e.g. squint, learning or speech problems;
  • Information on any injury in the context of a full paediatric assessment of child's growth, development and emotional well being;
  • Summary of all the findings (history, examination, any investigations undertaken), to be followed by a professional opinion; (e.g. definite abuse, definite non-abuse, high suspicion of abuse, low suspicion of abuse, or non-specific that is equal likelihood of abuse or non-abuse);
  • Where applicable, to include recommendations for future health care needs and other non-health care needs where relevant. Details of any follow-up arrangements to be made.

The Named Nurse for Child Protection and (if relevant) the Designated Nurse for safeguarding looked after children should be informed that a medical assessment has taken place. Copies should be sent to the relevant Named/Designated Doctor.

All reports and diagrams should be signed and dated by the doctor undertaking the examination. All the diagrams should have the child's name and record / case number.

Body Charts / Photo Documentation

Agreed body charts should be used for both physical and sexual abuse and appended to the report.

Photographs should be taken by a trained doctor or NHS photographer and originals may be shared with the police as part of the medical report. Photographs taken by the scenes of crime officer should be made available to the paediatrician to comment on in the medical report.

Apart from minority of children who present to hospital as emergency, the child protection medical examinations are done by a paediatrician, either at one of the three Child Development Centres in the West or at the Child Abuse Suite in the Lister Hospital in the East.

Photo documentation in sexual abuse should be sealed in an envelope in the notes and /or retained separately from the child's details in a safe store (e.g. download of the colposcope exam onto a DVD and kept with the notes). Intimate photographs should not be passed to Children's Services staff.


13. Analysis and Assessment of Risk

The scope and focus of the assessment during the Section 47 Enquiry will be of an assessment specifically addressing the risks for the child(ren) and specifically:

  • Identify clearly the initial cause for concern;
  • Collect information from agency records and other agencies;
  • Describe the family history and that of the child(ren);
  • Describe the family structure and network;
  • Evaluate the quality of attachments between child(ren) and carers;
  • Evaluate the strengths of the family;
  • Consider the impact of any parental risk factors e.g. domestic abuse, substance misuse and/or mental health issues;
  • Consider the child's needs for protection;
  • Evaluate information from all other sources, including any previous assessments;
  • Consider the ability of parents and wider family and social networks to safeguard and promote the child's welfare;
  • Possible actions to enhance the strengths in the situation and minimise effects of risk;
  • Evaluate the risks to the child.

Where the child's circumstances are about to change the risk assessment must include an assessment of the safety of the new environment e.g. where a child is to be discharged from hospital to home the assessment must have established its safety and implemented any support plan required to meet the child's needs. There should be a discharge planning meeting chaired by the Children's Services Team Manager.


14. Professional Disagreement at Enquiry Stage

Disagreements over the handling of concerns reported to Children's Services typically occur when:

  • The referral is not considered to satisfy eligibility criteria for assessment;
  • Informal advice is sought and a social worker has concluded that a referral is required;
  • Children's Services conclude that further information should be sought by the referrer before the referral is progressed;
  • Children's Services believe that an Assessment can be started without invoking child protection procedures;
  • Children's Services consider that child protection procedures must be invoked;
  • Children's Services and the Police Joint Child Protection Investigation Team (JCPIT) place different interpretations on the need for a Section 47 Enquiry / criminal investigation;
  • Disagreement exists about the justification for convening an Initial Child Protection Conference.

If the professionals are unable to resolve differences through discussion and/or meeting within a time scale, which is acceptable to both of them, their disagreement must be addressed by more experienced / more senior staff. This should be referred to the Head of Child Protection.

With respect to most day to day difficulties this will require a Children's Services Team Manager liaising with her/his equivalent in the relevant agency, e.g.:

  • A detective sergeant in the Joint Child Protection Investigation Team (JCPIT);
  • A senior health visitor / nurse / GP;
  • Designated senior person.

If agreement cannot be reached following discussions between the above 'first line' managers (who should normally seek advice from designated /named / lead officer/ Principal Officers) the issue must be referred without delay through the line management to the equivalent of service manager / detective inspector / Head Teacher or other Designated Professional.

Alternatively, and more commonly in health services, input may be sought directly from designated doctor or nurse in preference to use of line management.

Records of discussions must be maintained by all the agencies involved.


15. Outcome of Section 47 Enquiries

At the completion of the planned enquiry, the social worker and line manager should decide how to proceed, usually following further Strategy Discussion(s) with relevant agencies and professionals. The aim of the Strategy Discussion at this point is to share information, plan any further enquiries and agree outcomes (See Strategy Discussion and Meetings Procedure).

In all cases the Children's Service Manager must authorise the outcome and any plans for further service.

Concerns not Substantiated

If, on conclusion of the investigation, it is felt that the S47 enquiry has been unfounded or safeguarding arrangements are such that there is no need to continue services with Child Protection procedures, this should be referred to the relevant Group Manager with a recommendation from the Team Manager. He or she will ratify any decision to end the S47 investigation, and confirm the ongoing plan for the child. A management decision should be placed on LCS under the “Management Decision” tab, explaining why the risk has diminished sufficiently for the child(ren) to come out of S47 processes and what a more appropriate outcome should be.

If the relevant Service Manager is unavailable, the matter should be referred across to another Service Manager or to a Head of Service.

Where the concerns are not substantiated it may still be important to complete the Assessment and consider if further help or support is needed using a Child In Need plan or a Common Assessment Framework CAF.

Concerns Substantiated: Child Judged to be likely to suffer Significant Harm

Where concerns are substantiated and the child is assessed to have suffered, or is likely to suffer, significant harm the line manager must authorise the convening of an Initial Child Protection Conference and completion of the Assessment (if incomplete), having ensured the child / any others in the household and the child's carers have been seen.

Where legal action is indicated the Children's Services Practice manager must be informed and take the final decision, following a Legal Planning meeting which must be chaired by the Children's Services Manager.

The social worker must prepare the child for the conference and help them with this, or make representations through a third party. The child and the parents must understand the purpose of the conference.


16. Recording of Section 47 Enquiries

All agencies must keep accurate and detailed records of information, actions and decisions relating to the Section 47 Enquiry, using any agency pro-forma, (legibly) signed and dated by the staff or inputted into the electronic record.

Both the police Joint Child Protection Investigation Team (JCPIT) and Children's Services records must identify managers' decision making on forms and in electronic records.

Children's Services recording of enquiries should include:

  • Agency checks (reasons for not contacting key agencies should be included);
  • Records of contact with child and family members;
  • Strategy Discussion/Meeting notes;
  • Details of the enquiry;
  • Body maps (where applicable);
  • Assessment including identification of risks and how they may be managed (could be recorded within the Strategy Discussion/Meeting notes);
  • Decision making processes;
  • Outcome / further action planned.

Record of Outcome of Enquiries

The outcome must be clearly recorded, with the reasons for decisions clearly stated on the LCS Outcome of Section 47 Enquiries Record. If the Service Manager decides that it is not appropriate to convene an Initial Child Protection Conference they must consider for each child subject to the Section 47 enquiry whether support services such as a Child in Need Plan, CAF or other services are required to meet their needs. If the Service Manager decides that an Initial Child Protection Conference will be convened, they must set out in the case record of each child subject to the Section 47 enquiry the significant harm that each child is likely to suffer in the future and from whom.

This decision should be notified to all other statutory agencies that agency checks have been requested from.

At the completion of enquiries, Children's Services line manager must ensure that the concern and outcome have been entered manually on a chronology at the front of each file / on the electronic record.

Note that this applies to unborn babies were the siblings are already subject of a child protection plan – refer to Section 3, Threshold for Section 47 Enquiries.

Feedback from Enquiries

Parents, and children of sufficient age and appropriate level of understanding, together with those agencies, professionals and foster carers significantly involved in the enquiry, should be given written information on the outcome of the enquiry (in advance of any subsequent Child Protection Conference held).

Feedback about outcomes should be provided to non-professional referrers in a manner that respects the confidentiality and welfare of the child. If there are ongoing criminal investigations, the content of the social workers feedback should be agreed with the Police Joint Child Protection Investigation Team (JCPIT).

Disputed Decisions

When Children's Services has concluded an Initial Child Protection conference is not required but professionals in other agencies remain seriously concerned about the child's safety, they should follow the procedure in Section 15, Professional Disagreement at Enquiry Stage above.


17. Timescales

Routine

The following timescales set out below mean that the Strategy Discussion which instigates the Section 47 Enquiry and the Assessment, which began at the point of referral, may lead to the Initial Conference taking place before the completion of the Assessment:

  • The assessment must be completed within 45 working days of the receipt of the referral;
  • The maximum period from the Strategy Discussion, where the decision was made to proceed with a Section 47 Enquiry, to the Initial Child Protection Conference is 15 working days.

Where more than one Strategy Discussion/Meeting takes place care must be taken to review the timescales and ensure that the child(ren) are protected while the enquiries are taking place.

Exceptions

The time-scales above are the standards required by Working Together to Safeguard Children 2015. Where the welfare of the child requires shorter time-scales these must be achieved.

There may be exceptional circumstances where it is not in the child's interests to work to the above time-scales. The circumstances which may lead to an alternative time-scale include:

  • The need to engage interpreters, translators etc. for those with communication needs (including disabled children);
  • Pre-birth assessments.

Any proposal to justify variation of routine time scales must be authorised by the Children's Services Manager (CSM) following line manager's consultations with the Police Joint Child Protection Investigation Team (JCPIT) and any relevant agencies.

Reasons for diverging from these time-scales must be fully recorded together with a plan of action detailing alternative arrangements.


18. Children Services’ process to ensure ICPCs are held within 15 working days of the Strategy Discussion/Meeting where the Decision was taken to commence a Section 47 Enquiry

Day 1 Initial Strategy Discussion/Meeting:

The Practice Manager will record, within the strategy discussion minutes on LCS, an instruction to the child’s social worker. The social worker will book an Initial Child Protection Conference (ICPC), with the Child Protection and Statutory Review Service (CP and SRS), by Day 5 of the S47 enquires, if, after the initial stages of investigation, the concerns are assessed as significant.

By Day 5:

The social worker will have sent a request for an ICPC and the invitation list to the CP and SRS. The CP and SRS will allocate an ICPC meeting, time and venue.

Days 5 - 8:

If necessary the Social Worker will send details of additional invitees identified to CP and SRS.

By Day 8:

The Group Manager  will record a management direction on LCS if an ICPC is subsequently considered not to be required, with reasons, and forward to CP and SRS.

Day 8:

The CP and SRS will send out the invitations to the ICPC.

After Day 8:

If the Social Work team identifies additional invitees to ICPC from this point, the team will be responsible for inviting them.

Day 8 to Day 15:

If the Practice Manager decides that the evidence collected from the section 47 enquires and the social work assessment no longer requires that the case progresses to an ICPC, then the Practice Manager will discuss this with the Group Manager. The Group Manager will authorise the decision and record it immediately as a management decision on LCS. The social work team will contact CP and SRS to cancel the ICPC promptly. The CP and SRS will send out cancellation letters. 

The SW Team must inform the CP and SRS within 1 working day of the Group Manager decision to cancel the ICPC, so that the slot can be allocated to another case in a timely way. If the social worker fails to inform CP and SRS and no acceptable reason is given, the CP and SRS will inform:

  • On the first occasion the Practice Manager;
  • On the second occasion the Practice Manager and Group Manager;
  • On third and any subsequent occasions the Head of Service, Group Manager and Practice Manager.

End