SCOPE OF THIS CHAPTER
This chapter provides the steps for how to undertake a strategy discussion / meeting and how to conduct Section 47 Enquires.
This chapter was amended in January 2021 when Section 4, Strategy Discussion / Meeting was updated and a link to the GMC Guidance “Protecting children and young people: The responsibilities of all doctors” was added to Section 8, Medical Assessments.
- Duty to Conduct Section 47 Enquiries
- Immediate Protection
- Section 47 Thresholds and the Multi Agency Assessment
- Strategy Discussion / Meeting
- The Section 47 Enquiry
- Single Agency and Joint Agency Section 47 Enquiries and Joint Police and Social Care Enquiries
- Involving Children, Parents and Other Significant Family Members
- Medical Assessments
- Pre-Birth Assessments
- Achieving Best Evidence Interviews
- The Outcome of Section 47 Enquiries
- Timescales for Section 47 Enquiries
1. Duty to Conduct Section 47 Enquiries
When the local authority social worker receives a referral and information has been gathered during an assessment (which may have been very brief), in the course of which a concern arises that a child may be suffering, or likely to suffer, significant harm, the local authority is required by Section 47 of the Children Act 1989 to make enquiries. The purpose of this multi-agency enquiry and assessment is to enable the agencies to decide whether any action should be taken to safeguard and promote the welfare of the child. Any decision to initiate an enquiry under Section 47 must be taken following a Strategy Meeting/Discussion.
Responsibility for undertaking Section 47 enquiries lies with the Local Authority Children's social care in whose area the child lives or is found. 'Found' means the physical location where the child suffers the incident of harm or neglect (or is identified as likely to suffer harm or neglect), e.g. nursery or school, boarding school, hospital, one-off event, such as a festival, holiday home or outing or where a privately fostered or looked after child is living with their carers. For the purposes of these procedures the Children's social care area in which the child lives, is called the 'home authority' and the Local Authority Children's social care area in which the child is found is the child's 'host authority'.
Multi-agency Information Checks:
The social worker together with their manager must decide at what point and whether to seek parental permission to undertake multi-agency checks. If the manager decides not to seek permission, they must record the reasons why, for example it may:
- Be prejudicial to the child's welfare;
- Have serious concern about the behaviours of the adult;
- Have serious concern that the child would be exposed to immediate risk of harm;
- Jeopardise a police investigation.
Where permission is sought from parents and carers and denied, the manager must determine whether to proceed, and record the reasons for the decision they make.
The police, health professionals, teachers and other relevant professionals should support the Local Authority in undertaking the enquiries. When requested to do so by Children's social care, professionals from other parts of the local authority such as housing, schools and those in health organisations have a duty to cooperate under Section 27 of the Children Act 1989 by assisting the local authority in carrying out its Children's social care functions. The social worker must contact the other agencies involved with the child to inform them that a child protection enquiry has been initiated and to seek their views. The checks should be undertaken directly with involved professionals and not through messages with intermediaries. The relevant agency should be informed of the reason for the enquiry, whether or not parental consent has been obtained and asked for their assessment of the child in the light of information presented
Practitioners may refer to the Nottinghamshire Information Sharing Protocol for further guidance.
2. Immediate Protection
Where there is a risk to the life of a child or the possibility of serious immediate harm, an agency with statutory child protection powers (the police and children's social care) should act quickly to secure the immediate safety of the child.
When considering whether emergency action is required, an agency should always consider whether action is also required to safeguard and promote the welfare of other children in the same household (e.g. siblings), the household of an alleged perpetrator, or elsewhere.
Planned emergency action will normally take place following an immediate Strategy Discussion/Meeting between police, children's social care, health professionals and other agencies as appropriate.
If it is necessary to remove a child from their home, a local authority must, wherever possible and unless a child's safety is otherwise at immediate risk, apply for an Emergency Protection Order (EPO). Where there is an immediate risk of Significant Harm the Police may take a child into Police protection.
Police powers of protection should only be used in exceptional circumstances where there is insufficient time to seek an EPO or for reasons relating to the immediate safety of the child.
Where there is a risk to the life of a child or the possibility of serious immediate harm, an agency with statutory child protection powers (the police and children's social care) should act quickly to secure the immediate safety of the child.
3. Section 47 Thresholds and the Multi Agency Assessment
A Section 47 Enquiry must always be commenced immediately following a strategy Discussion/Meeting when:
- There is reasonable cause to suspect that a child is suffering or likely to suffer significant harm in the form of physical, sexual, emotional abuse or neglect;
- Following an EPO or the use of police powers of protection is initiated.
The threshold criteria for a Section 47 Enquiry may be identified during an early assessment or it may become apparent at the point of referral, during multi-agency checks or in the course of a multi agency assessment.
A multi agency assessment (see Assessment Procedure) is the means by which Section 47 Enquiries are carried out. The assessment will have commenced at the point of receipt of referral and it must continue whenever the criteria for Section 47 Enquiries are satisfied. The conclusions and recommendations of the Section 47 Enquiry should inform the assessment which must be completed within 45 working days of the date when the referral was received.The enquiries and assessment should always involve separate interviews with the child subject to their age and development and understanding In the majority of cases, the parents/carers will be interviewed, and the interaction between the parent/carers and child will contribute to the assessment.
4. Strategy Discussion / Meeting
When to hold a strategy discussion / meeting
Whenever there is reasonable cause to suspect that a child or unborn child is suffering, or is likely to suffer, significant harm, there should be a strategy discussion/meeting. The strategy discussion or meeting should be co-ordinated and chaired by a children's social care Team Manager. Any decision not to hold a strategy discussion or to delay a strategy discussion should be recorded along with the rationale.
A strategy discussion / meeting MUST be convened when:
- Any new referrals in respect of a child where there are concerns that a child is suffering, or is likely to suffer, significant harm;
- When new information on an existing case in children's social care indicates that a child is likely to suffer significant harm;
- The death of a child in family, in which abuse or neglect is suspected, is confirmed and there are other children in the household.
A strategy discussion / meeting should be considered when:
- A child lives in, or is born to, a household in which resides another child who is currently the subject of a Child Protection Plan;
- A child who is currently the subject of a Child Protection Plan in another area moves into Nottinghamshire or Nottingham City;
- A child has sexually assaulted another child or there is a risk of such an assault occurring to another child in the same household or in regular contact with the household.
(This is not an exhaustive list)
Who should be involved in the discussion / meeting?
A local authority social worker, health practitioners and a police representative should, as a minimum, be involved in the strategy discussion. Other relevant practitioners will depend on the nature of the individual case but may include:
- The practitioner or agency which made the referral;
- The child’s school or nursery;
- Any health or care services the child or family members are receiving ;
- In the case of a pre-birth strategy discussion/meeting this should involve the midwifery services;
- Where a child or young people may require a medical examination as part of the child protection enquiries the on-call consultant paediatrician at the appropriate hospital should be part of the initial strategy discussion/meeting. In the case of concerns regarding sexual abuse a medical assessment should always be considered.
Professionals participating in strategy discussions/meetings must have all their agency's information relating to the child available to be able to contribute to the discussion/meeting, and must be sufficiently senior to make decisions on behalf of their agencies.
Purpose of the Strategy Meeting / Discussion
Local authority children’s social care should convene a strategy discussion to determine the child’s welfare and plan rapid future action if there is reasonable cause to suspect the child is suffering or is likely to suffer significant harm.
Strategy discussion tasks
The discussion should be used to:
- Share available information;
- Agree the conduct and timing of any criminal investigation;
- Decide whether enquiries under section 47 of the Children Act 1989 must be undertaken;
- Decide whether a single or joint police and social care enquiry is appropriate.
Where there are grounds to initiate an enquiry under section 47 of the Children Act 1989, decisions should be made as to:
- What further information is needed if an assessment is already underway and how it will be obtained and recorded;
- What immediate and short-term action is required to support the child, and who will do what by when;
- Whether legal action is required.
Roles and responsibilities
Team Manager, children’s social care should:
Convene the strategy discussion and make sure it:
- Considers the child’s welfare and safety, and identifies the level of risk faced by the child and any sibling or other child that potentially may be impacted;
- Decides what information should be shared with the child and family (on the basis that information is not shared if this may jeopardise a police investigation or place the child at risk of significant harm);
- Agrees what further action is required, and who will do what by when, where an EPO is in place or the child is the subject of police powers of protection;
- Record agreed decisions about the outcome of the strategy discussion and any further actions that are needed;
- Share the record of decisions/actions with attendees as soon as practicable;
- Follows up actions to make sure what was agreed gets done.
Health practitioners should:
- Advise about the appropriateness or otherwise of medical assessments, and explain the benefits that arise from assessing previously unmanaged health matters that may be further evidence of neglect or maltreatment;
- Provide and co-ordinate any specific information from relevant practitioners regarding family health, maternity health, school health mental health, domestic abuse and violence and substance misuse to assist strategy and decision making;
- Secure additional expert advice and support from named and/or designated professionals for more complex cases following preliminary strategy discussions;
- Undertake appropriate examinations or observations, and further investigations or tests, to determine how the child’s health or development may be impaired.
The Police should:
- Discuss the basis for any criminal investigation and any relevant processes that other organisations and agencies might need to know about, including the timing and methods of evidence gathering;
- Lead the criminal investigation (local authority children’s social care have the lead for the section 47 enquires and assessment of the child’s welfare where joint enquiries take place).
The strategy discussion or meeting may be either a face to face multi-agency meeting or phone discussion and more than one discussion may be necessary.
There may be a need for an urgent discussion to make immediate decisions, followed by a meeting to further co-ordinate multi-agency response and activity.
Where the strategy discussion is via phone conference call facilities should be used wherever possible to enable the participation of all relevant practitioners at the same time
Strategy discussions/meetings should be convened by a Team Manager from children’s social care as soon as possible bearing in mind the immediacy of the risk of harm to the child, the need to protect the child and necessity to co-ordinate action such as securing evidence that is critical to the investigation.
An initial strategy discussion will be needed to address immediate decisions around measures to ensure the safety of the child and to agree the basis on which any future work should take place. Where these concern new referrals it is likely that they will involve practitioners in the MASH/Children and Families Direct. When new information comes to light regarding a child that is already open to children social care it is the responsibility of the allocated social worker to arrange a strategy discussion/meeting promptly.
The need for follow up strategy discussions/meetings will depend on the nature of the case. Where ongoing coordination of multi-agency work is needed during the s.47 enquiry or criminal investigation these should be scheduled to support the decision making and coordination of actions for that case.
There should be a clear and defined decision as a result of the strategy meeting which would result in one of the following actions:
- A decision that the threshold has been met to initiate a Section 47 enquiry;
- That further assessment is required;
- That the case can be progressed within a Section 17 Child in Need framework;
- That non statutory support can address the need through early help or targeted support;
- No further action is required.
A record of the outcome of the strategy discussion, including decisions made and actions agreed, should be shared with attendees by children’s social care within a maximum of two working days.
5. The Section 47 Enquiry
Children's social care is the lead agency for Section 47 Enquiries (Children Act 1989) and the Children's social care manager has responsibility for authorising a Section 47 Enquiry following a strategy discussion/meeting.
The Section 47 Enquiry and assessment must be led by a qualified social worker from Children's social care, who will be responsible for its coordination and completion. The social worker must consult with other agencies involved with the child and family to obtain a fuller picture of the circumstances of all children in the household, identifying parenting strengths and any risk factors. Enquiries may also need to cover children in other households with whom the alleged offender may have had contact. All agencies consulted are responsible for providing information to assist.
At the same time, where there is a joint investigation the Police will have to establish the facts about any offence that may have been committed against a child and collect evidence as they lead the criminal investigation.
The Section 47 Enquiry should begin by focusing on the information identified during the referral/assessment and strategy discussion, which appears most important in relation to the risk of significant harm.
The assessment of risk will:
- Identify the cause for concern, its seriousness, any recurring events and the vulnerability and resilience of the child;
- Consider historical information and a chronology of significant events;
- Evaluate the strengths, including protective factors and weaknesses of the family;
- Evaluate the risks to the child/ren and the context in which they are living;
- Consider the child's needs for protection; from whom or what and how this can be achieved;
- Consider the capacity of the parents and wider family and social networks to safeguard and promote the child's welfare - this must include both parents, any other carers, such as grandparents, and any partners of the parents;
- Risk factors that may suggest a higher level of vulnerability in the family and risk of significant harm (e.g. parental mental health difficulties, parental substance misuse, and domestic violence or immigrant family issues such as social isolation or combinations of these);
- Determine the level of intervention required for the child to be safeguarded in the immediate, interim and longer term.
Multi agency information checks:
The social worker must contact other agencies involved with the child to inform them that a Section 47 Enquiry has been initiated and to seek their views. The checks should be undertaken directly with involved professionals and not through messages with intermediaries.
The relevant agency should be informed of the reason for the enquiry, as well as whether or not parental consent has been obtained, and asked for their assessment of the child in the light of information presented.
Agency checks should include accessing any relevant information that may be held in other parts of the United Kingdom or in any other country. See also Working with Foreign Authorities: Child Protection Cases and Care Orders.Children's social care must ensure that each child is the subject of an assessment of their needs and that the outcome of this assessment is shared in writing with relevant organisations in a timely manner.
6. Single Agency and Joint Agency Section 47 Enquiries and Joint Police and Social Care Enquiries
The police and children's social care must co-ordinate their activities to ensure the parallel process of a Section 47 Enquiry and a criminal investigation is undertaken in the best interests of the child. This should primarily be achieved through joint activity and planning at strategy discussions/meetings.
The primary responsibility of police officers is to undertake criminal investigations of suspected or actual crime and to inform children's social care when they are undertaking such investigations, and where appropriate to notify the Local Authority Designated Officer (LADO) in specific cases where there are allegations against people working in a paid or voluntary capacity with children.At the strategy discussion/meeting the police officers should share current and historical information with other services where it is necessary to do so to ensure the protection of a child. Working Together to Safeguard Children states that: The police should assist other agencies to carry out their responsibilities where there are concerns about the child's welfare, whether or not a crime has been committed. If a crime has been committed, the police should be informed by the Local Authority children's social care department.
The local protocol agreed between the Police and Children's Social Care for those cases, which will progress through joint enquiries, covers the following:
- Sexual abuse;
- Serious physical injury (including bruising and soft tissue injuries to babies, repeated referrals on pre-school children; bite marks which need further exploration);
- Serious neglect;
- Abandonment of young children;
- Complex circumstances, for example, organised abuse or medical conditions involving fabricated and induced illness, particularly where the investigatory skills of the Police may be of assistance;
- Enquiries concerning allegations of abuse whilst a child is in a foster, adoptive or child minding household and allegations of abuse by a worker or volunteer in contact with children.
The Detective Inspector, Child Abuse Investigation Unit should also be consulted and consideration should be given to joint enquiries in cases where:
- There have been previous child abuse allegations in respect of the child or the alleged perpetrator;
- The child is unable to give a clear, coherent and credible account of how the injuries occurred;
- The explanation given by the child/other person is not consistent with the injuries;
- Information from other agencies adds to the concerns or identifies new ones.
Where joint enquiries take place the Police have the lead for the criminal investigation and Children's Social Care have the lead for Section 47 enquiries and the child's welfare. Children's social Care will work in partnership with the Medical Examiners in local areas to ensure children receive appropriate and timely medical examinations, assessments and any treatment required as outlined in Section 8, Medical Assessments.
All other cases that meet the threshold for enquiries under Section 47 will be dealt with initially by Children's Social Care alone. Such cases are likely to include:
- Emotional abuse;
- Enquiries into the circumstances of unborn babies;
- Children on Care Orders returning home under the 'Care Planning, Placement and Case Review Regulations 2011 where they are returning to the household from which they were removed for concerns regarding significant harm and assessment indicates the need for a protection plan;
- Children moving into a household where another child is subject to a Child Protection Plan;
- Children moving into the area who are subject to a Child Protection Plan in another area;
- The presence in, or the return to the household, of a person who is known to have committed a relevant offence and presents a continuing risk of harm to children, or where further assessment of the individual is required.
Section 47 enquiries must be undertaken in respect of all children in the household.
7. Involving Children, Parents and Other Significant Family Members
Children who are the subject of Section 47 Enquiries should always be seen and communicated with alone by the social worker. In addition, all children within the household must be directly communicated with during Section 47 Enquiries by either the police or children's social care or both agencies, so as to enable an assessment of their safety to be made.
The children who are the focus of concern, must be seen alone, subject to their age and willingness, preferably with parental permission.
If the child is the subject of ongoing court proceedings, legal advice must be sought about obtaining permission from the court to see the child.
Children's social care and the police should ensure that appropriate arrangements are in place to support the child through the Section 47 Enquiry. Specialist advice / help may be needed if:
- The child's first language is not English;
- The child appears to have a degree of psychological and/or psychiatric disturbance but is deemed competent;
- The child has a physical/sensory/learning disability;
- Interviewers do not have adequate knowledge and understanding of the child's ethnic, faith and cultural background;
- Unusual abuse is suspected, including the use of photography or filming or internet grooming ( in which case the method of interviewing the child might need to be revised).
It may be necessary to provide information to the child in stages and this must be taken into account in planning the Section 47 Enquiries.
Explanations given to the child must be brought up to date as the assessment and the enquiry progresses. In no circumstances should the child be left wondering what is happening and why
If the whereabouts of a child subject to Section 47 Enquiries are unknown and cannot be ascertained by the social worker, the following action must be taken within 24 hours:
- A strategy discussion/ meeting with the police;
- Agreement reached with the children's social care manager responsible as to what further action is required to locate and see the child and carry out the enquiry.
If access to a child is refused or obstructed, the social worker, in consultation with their manager, should co-ordinate a strategy discussion/meeting including legal representation, to develop a plan to locate or access the child/ren and progress the Section 47 Enquiry.
The parents and other significant family members:
In most cases, parents should be enabled to participate fully in the assessment and enquiry process, which must be explained to them verbally and also in writing. If a parent has a specific communication difficulty or English is not their first language, an interpreter should be provided.
The social worker has the main responsibility to engage with parents and other family members to ascertain the facts of the situation causing concern and to assess the capacity of the family to safeguard the child.
Parents must be involved at the earliest opportunity unless to do so would prejudice the safety of the child. The needs and safety of the child will be paramount when determining at what point parents or carers are given information. Parents must be kept informed throughout about the enquiry, its outcome and any subsequent action unless this would jeopardise the welfare of the child.
The assessment must include both parents, any other carers such as grandparents and the partners of the parents as well as any other adult members of the household.
Where a parent lives elsewhere but has contact with the child arrangements should be made for their involvement in the assessment process.
Appropriate, checks should be completed on a parent, who assumes the care of a child during a Section 47 Enquiry.
An explanation of their rights as parents including the need for support and guidance from an advocate whom they trust should be provided, including advice about the right to seek legal advice.
Any objections or complaints expressed by parents during a Section 47 Enquiry, and the response to these objections or complaints, must be clearly recorded.
8. Medical Assessments
Strategy Discussions / Meetings must consider, in consultation with the Consultant Paediatrician on call for child protection the appropriateness and the timing of a paediatric assessment.
Consideration of a paediatric assessment is an essential component of a child protection investigation. It is important to recognise that a paediatric assessment is a comprehensive assessment which includes the clinical history, examination, and detailed documentation including the use of line drawings and photographs. Additionally, the assessment includes obtaining any relevant investigations and forensic samples, arranging any necessary aftercare and writing a report with an opinion. It should be conducted with the same degree of thoroughness and attention to detail as an examination for any potentially life threatening medical condition.A paediatric assessment should demonstrate a holistic approach to the child and assess the child's well-being, including mental health, development and cognitive ability.
The paediatric assessment has a number of purposes:
- To identify the child's health needs;
- To help to reduce the physical and psychological sequel of such abuse;
- To determine the likelihood of child abuse on the balance of probability;
- To facilitate the police investigation of a possible crime by documentation of clinical findings, including injuries and taking samples that may be used as forensic evidence in a police investigation relevant to all types of abuse;
- To contribute to the multi-agency assessment through sharing of information.
Only doctors who have gained appropriate informed consent may physically examine the whole child. All other staff should only note any visible marks or injuries on a body map and record, date and sign details in the child's file. A paediatric assessment cannot provide a detailed assessment of the child or young person's mental health or cognitive ability. If it is felt that this is required this will need to be organised with the appropriate specialist service.
If the child has bite marks:
Human bites are always inflicted injuries. They are currently the only physically abusive injury where there is the potential to identify the perpetrator. This may be from dental characteristics or from salivary DNA. Therefore, it is essential that if a child has an injury thought to be a bite mark they are referred to a Forensic Odontologist. Many human bites are not recognised as such and are dismissed as bruises. Any bruise with the shape of opposing curves should be treated as suspicious and the services of a Forensic Odontologist sought early in the investigation. The Forensic Odontologist will take dental impressions of any suspected perpetrators and make a comparison with the bite mark on the skin (this may also apply to children who are accused of causing the bite) and, if necessary, will present the evidence in court as an expert witness.
Forensic Odontologists can either directly examine the child or work from photographs (taken according to appropriate technique – see below).
If a child is referred to Childrens Social Care with an alleged bite mark the procedures should be followed as for any potential inflicted injury but the referral to a Forensic Odontologist should be discussed at the strategy discussion stage and arranged by the Police. A joint assessment with the Odontologist and the Paediatrician should then ideally be arranged. Some injuries may not be recognised as potential bite marks until the child is examined by the Paediatrician. If this is the case the social worker accompanying the child should contact their team manager to speak to the Police to arrange a suitable forensic odontology assessment as soon as possible.
This early referral allows the bite mark to be assessed for its DNA potential, and / or the seizing of any clothing that has been bitten into or through. Once that is completed, an assessment of the bite mark will be carried out by the Odontologist. If it is felt that the mark will reveal specific qualities to enable a subsequent comparison to be made, then the photographic process commences.
Over a period of 6 to 7 days, the bite mark should be photographed, at the same approximate time, from the same direction / angle and, wherever possible, by the same photographer. This should be arranged by the police who will always do this using forensically appropriate bite mark scales to ensure accuracy during the comparison process. These CSI standards for 'criminal / forensic comparisons' are well established, tried, tested and, most importantly, accepted in a court of law.
Sexual Abuse Medical Examinations should always be conducted jointly by both a Senior Paediatrician with appropriate skills and training and a Forensic Medical Examiner – irrespective of whether the examination is recent / historic. This includes oral rape examinations.
Please refer to the chart, Organising a Medical for guidance on arranging child protection medicals.
Consent or other authority must be obtained before examining, investigating or treating a child or young person.
Consent or authorisation to a medical assessment can be given by:
- A child of sufficient age and understanding (Gillick competency/Fraser guidelines);
- Any person with parental responsibility, providing they have the capacity to do so;
- The local authority when the child is the subject of a care order (though the parent should be informed);
- The local authority when the child is accommodated under s20 of the Children Act 1989, and the parent/s have abandoned the child or are assessed as lacking capacity 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;
- 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 medical assessment or emergency treatment;
- A young person aged 16 or 17 has an explicit right (s8 Family Law Reform Act 1969) to provide consent to surgical, medical or dental treatment and, unless grounds exist for doubting their mental health, no further consent is required;
- A child who is of sufficient age and understanding may refuse some or all of the medical assessment, though refusal can potentially be overridden by a court.
A child who is of sufficient age and understanding may refuse some or all of the medical assessment, though refusal can potentially be overridden by a court.
Wherever possible the permission of a parent should be sought for children under sixteen prior to any medical assessment and/or other medical treatment.
Where 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 their own consent;
- Decide to proceed without consent.
In these circumstances, parents must be informed by the medical practitioner as soon as possible and a full record must be made at the time
If a non-competent child or young person refuses to be examined it must be carefully weighed up the potential harm to the rights of the child or young person of overriding their refusal against the benefits of examination or treatment, ensuring that decisions can be taken in their best interests. In such circumstances the involvement of other members of the multi-disciplinary team, an independent advocate, or a named or designated doctor for child protection should be considered. Legal advice may be helpful in deciding whether it is in the child's best interests for the social worker and manager to seek a court order to resolve disputes about best interests that cannot be resolved informally.
Advice should also be sought from the above professionals, before seeking legal advice, if parents/carers, or a competent young person refuses examination or treatment that are felt to be in the best interests of a child or young person.
The only circumstances where examination and treatment to a child or young person can be given without consent is where 'the treatment is immediately necessary to save their life or to prevent a serious deterioration of their condition. The treatment you provide must be the least restrictive of the patient's future choices' Protecting children and young people: The responsibilities of all doctors.
Arranging the medical assessment:
For the contact arrangements for arranging a medical in cases of suspected Physical or Sexual abuse, see the chart, Organising a Medical.
In the course of Section 47 Enquiries, appropriately trained and experienced practitioners must undertake all medical assessments. Where it is felt that further specialist opinion is required e.g. radiologist, orthopaedic, ophthalmology, neurologist, plastic surgeon the paediatrician may summarise the specialist opinion within a single paediatric report. If unable to do so a separate report should be provided by any specialist involved. If further clarity is required by agencies subsequently this should be sought directly from the specialist involved.
A social worker should attend the assessment and a handwritten summary will be provided at the end of the medical examination to the attending Social Worker to assist with ongoing safeguarding/criminal investigations. This summary may be provided to the police by the Social Worker.
A full written report should be provided by the examining paediatrician within 3 working days to:
- Health visitor for preschool children;
- Community Child Health Service (where there is a separate service provider);
- Children's social care;
- Appropriate personnel for the reasons of supervision and audit; and
- A copy should be kept in the records;
- Any specialist whose opinion has been summarised within the report;
- Young person if requested and assessed as appropriate by professionals in case following consultation with police and social care.
In some cases the police will require a report in the form of a witness statement, rather than the full written report. This is a factual account (without third party comment) summarising the consultation and/or examination with an opinion of likely causation.
Consideration should be given to whether parents/carer should receive a copy of the medical report and this will require consultation with Police and Social Care particularly if there is an on-going criminal investigation. Parents/carers can request their child's records using the Data Protection Act and will receive copies of all letters and reports through their solicitor if legal proceedings are started.
The purpose of the report is:
- To provide a full, detailed account of a consultation and/or examination;
- To share information with professionals who 'need to know';
- To inform statutory agencies of the probability of abuse and risk of significant harm; and
- To assist the court in making a decision about the child's safety and welfare.
9. Pre-Birth Assessments
Early identification of the needs of a pregnant woman and her unborn child are likely to involve midwifery services and may involve a range of other agencies. In some circumstances, practitioners will identify more serious concerns about the welfare, including significant harm, of an expected baby. Specific guidance has been developed which covers actions and responsibilities with regard to high risk pre-birth assessments. See Safeguarding babies at birth and young infants where the risks are too great to leave them in the care of their parents: Practice Guidance and Toolkit (Nottingham City SCP, Oct 2013).
This guidance gives further information relating to:
- Legal planning meetings;
- Ante-natal parenting assessment;
- Birth protection planning meetings including out of hours arrangements and babies born at home;
- Pregnant women with learning disability and impaired mental capacity;
- Children in care who become pregnant;
- Plans for removal of a baby at birth;
- Discharge planning processes;
- A range of tools to support the assessment and protection process.
Where concerns or needs have been identified, that do not meet the criteria for intervention by Children's Social Care, then organisations should consider what single agency or multi agency provision is required to meet those needs. At this point the practitioner identifying the need should consider initiating a Common Assessment Framework to ensure this work is coordinated.
Practitioners should refer to the Safeguarding Guide and Practice Guidance - Parents who Misuse Substances Procedure, in relation to parental substance misuse, domestic violence (see Domestic Violence and Abuse Procedure) and others as appropriate (please consult Section 2 Safeguarding Guides for further information), where such concerns have been identified.
A referral to Children's Social Care should be made as soon as any agency identifies a concern or need that may place the baby at risk of significant harm when born. Social Care will accept the referral at the point that it is made. Agencies will not be asked to refer when the pregnancy has progressed to a certain point as such practice increases potential confusion and reduces the opportunity to ensure that clear plans are agreed and in place well before a child is born. In addition, any issues that raise concern about the health and well being of the baby whilst in utero should also be discussed with the appropriate health practitioner and referred where appropriate. A referral should always be made where:
- A parent or other adult in the household has been identified as posing a risk to children;
- A sibling in the household is or has been the subject of a Child Protection Plan within a relevant timeframe;
- Another child has previously been removed from the care of either parent (or parents partner), either temporarily or permanently, by a voluntary arrangement or by Court Order. Where the parent, their partner or any other member of the household has previously had a child removed, this will always lead to a Core Assessment. It is highly likely in such circumstances that an Initial Child protection Conference (ICPC) will be appropriate;
- The degree of parental substance misuse is likely to significantly impact on the baby's safety or development;
- The degree of parental mental illness/impairment is likely to significantly impact on the baby's safety or development;
- There are significant concerns about parental ability to self care and/or to care for the child even with the provision of services;
- A parent previously suspected of fabricating or inducing illness in a child;
- Where there is evidence of domestic violence initiate a risk assessment and refer to the Pathway to Provision (County) and Family Support Pathway (City);
- Any concerns relating to an unborn baby must be reported to children's social care without delay and social care will plan assessments from 12 weeks gestation. A referral to the Family Nurse Partnership for 1st time mothers aged 19 or under should be considered in parallel and must have been made and accepted prior to 26 weeks gestation.
Upon receipt of such a referral, where it is judged that the criteria for accessing Children's Social Care are met, an assessment will be carried out by a qualified Social Worker. The assessment should proceed under Section 47, of the Children Act 1989. As indicated above where the household, or a member of it, has previously had a child removed this will always lead to an in depth assessment.
The timing of the pre birth assessment is crucial in order to ensure full information is gathered and analysed so that it can be used within planning that takes place prior to the birth. The following points must be considered:
- As soon as child protection concerns are identified, the Section 47 enquiries and pre birth assessment should be initiated (but not earlier than 12 weeks);
- The Initial Child Protection Case Conference (ICPC) should be held within 15 days of Section 47 enquiries commencing and the pre birth assessment must be completed by this date;
- The ICPC should be held no later than 6 weeks before the expected date of delivery but may be held up to 3 months prior to this date;
- In most circumstances the pre birth assessment must be completed 6 weeks prior to the due date;
- In the event of a late presentation / concealed pregnancy, an immediate assessment is required incorporating checks with Health, Police, Probation, education, Mental Health, Adult services, and Family Community Teams and other local authorities where the family have lived previously;
- In the case of twins and other high risk pregnancies it is likely that they may deliver prematurely and in these situations efforts should be made to complete assessments by 30 weeks of pregnancy;
- The pre birth planning meetings must be convened following the ICPC and the birth protection plan clearly documented and shared with all agencies (see Safeguarding Babies at Birth and Young Infants Where the Risks are too Great to Leave Them in the Care of their Parents).
This pre birth assessment is undertaken with the purpose of enabling a full assessment of the:
- Identified risks and how far these will impact on the care of the expected child;
- Parental history, their family and community support networks and their ability to prepare for and adapt to the needs of the child, including parental capacity to change;
- Support needs of parents and whether these needs can realistically be met so that (where possible) they can provide safe care for their baby;
- Early identification of other family members who might be able to support or provide primary care.
As with all assessments, it is essential the pre-birth assessment includes the birth father and male partner (if different) wherever possible. If the birth father is not part of the household, it is still important to understand and assess what role the father/father's family will play in the baby's life.
Where the assessment concludes that the child will be at continuing risk of significant harm following its birth, then an Initial (Pre Birth) Child Protection Conference (ICPC) should be convened as detailed within these procedures. N.B. Where an existing child in the household is the subject of a Child Protection Plan then an ICPC in respect of the unborn child must be held at the earliest opportunity. Where the current assessment leads practitioners to actively consider separation of the child from the parent at birth, a legal planning meeting should be convened as soon as possible and prior to the conference. The outcome of the legal planning meeting will be considered at the ICPC.
The ICPC should be held within 15 days of Section 47 enquiries commencing and the pre birth assessment must be completed by this date. Serious case reviews have highlighted the particular vulnerability of pre-term babies and ideally the ICPC should be held no later than 4 weeks before the expected date of delivery but could be held up to 3 months prior to this date. This should not detract from or delay the need to undertake a full assessment and ensure appropriate interventions.
10. Achieving Best Evidence Interviews
Visually recorded interviews must be planned and conducted jointly by trained police officers and social workers in accordance with the 'Achieving Best Evidence in Criminal Proceedings' (2011). All events up to the time of the video interview must be fully recorded. Consideration of the use of video recorded evidence should take in to account situations where the child has been subject to abuse using recording equipment.
Where it has been agreed by the Police and Children's Social Care in a strategy discussion / meeting, that it is in the best interests of the child that a full criminal investigation will be carried out, the police are responsible for that investigation, including any investigative interview (visually recorded or otherwise) with the victim. Having responsibility for the criminal investigation does not mean that the police should always take the lead in the investigative interview. Provided both the police officer and social worker are competent interviewers there is no reason why either should not lead the interview.
Ordinarily the child's parents or carer will be involved in the decision to interview a child, however there will be exceptions to this, for example where a child is likely to be threatened or coerced into silence.
The issues to be explored, cognitive abilities of the child and offences to cover should be the subject of a specific strategy discussion to plan the interview.
ABE Strategy Discussion/Meeting
See also Section 4, Strategy Discussion / Meeting.
Agreements as to how the investigation is to proceed, including how the child will be interviewed, will take place within the strategy discussion. Before any visually recorded interview is conducted the following should be considered:
- Issues of consent – by both parent and child;
- The individual's circumstances;
- The purpose and likely value of a visually recorded interview in this case;
- Competency, compellability and availability of the child for cross examination;
- The child's ability and willingness to talk in a formal setting;
- The use of an intermediary and/or aids to communication (interviews involving intermediaries and/or aids to communication should be visually recorded unless there are exceptional circumstances for not doing so); and
- Preparation of the child for interview.
Planning the interview
Planning the actual interview with the child should be done by way of a meeting between professionals rather than over the telephone. However, efforts should be made to conduct the visually recorded interview as expeditiously as possible and the reason(s) for any delay(s) should be recorded.
It will be necessary to consult with experts or interpreters to agree what, if any, role they should take during the interview in the following circumstances:
- The child's first language is not English;
- They appear to have a degree of psychiatric disturbance but are deemed competent;
- They have a physical / sensory / learning disability;
- Members of the team do not have sufficient knowledge and understanding of the child's racial, religious or cultural background;
- Where unusual forms of abuse are suspected.
11. The Outcome of Section 47 Enquiries
Children's social care is responsible for deciding how to proceed with the enquiries and risk assessment based on the strategy discussion/meeting and taking into account the views of the child, their parents and other relevant parties (e.g. a foster carer). It is important that they ensure that both immediate risk assessment and long term risk assessment are considered. 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 the safety of the home environment and implemented any support plan required to meet the child's needs).
At the completion of the Section 47 Enquiry, children's social care must evaluate and analyse all the information gathered to determine if the threshold for significant harm has been reached.
The outcome of the Section 47 Enquiries may reflect that the original concerns are:
- Not substantiated; although consideration should be given to whether the child may need services as a Child in Need;
- Substantiated and the child is judged to be suffering, or likely to suffer, significant harm and an initial child protection conference should be called.
Concerns are not substantiated:
Social workers with their managers should:
- Discuss the case with the child, parents and other professionals;
- Determine whether support from any services may be helpful and help secure it; and
- Consider whether the child's health and development should be re-assessed regularly against specific objectives and decide who has responsibility for doing this.
All involved professionals should:
- Participate in further discussions as necessary;
- Contribute to the development of any plan as appropriate;
- Provide services as specified in the plan for the child; and
- Review the impact of services delivered as agreed in the plan.
The Children's social care manager must authorise the decision that an initial child protection conference is not required, having ensured that the child, any other children in the household and the child's carers have been seen and spoken with. This decision and the rationale for it should be clearly recorded on the child's file.
Arrangements should be noted for future referrals, if appropriate.
Concerns of significant harm are substantiated and the child is judged to be suffering, or likely to suffer, significant harm:
Social workers with their managers should:
- Convene an initial child protection conference. The timing of this conference should depend on the urgency of the case and respond to the needs of the child and the nature and severity of the harm they may be facing. The initial child protection conference should take place within 15 working days of a strategy discussion, or the strategy discussion at which section 47 enquiries were initiated if more than one has been held;
- Consider whether any professionals with specialist knowledge should be invited to participate;
- Ensure that the child and their parents understand the purpose of the conference and who will attend; and
- Help prepare the child if he or she is attending or making representations through a third party to the conference. Give information about advocacy agencies and explain that the family may bring an advocate, friend or supporter.
All involved professionals should:
- Contribute to the information their agency provides ahead of the conference, setting out the nature of the agency's involvement with the child and family;
- Consider, in conjunction with the appointed conference Chair (and the police when a criminal investigation is underway or being considered), whether the report can and should be shared with the parents and if so when; and
- Attend the conference and take part in decision making when invited;
- Suitable multi-agency arrangements must be put in place to safeguard the child until such time as the initial child protection conference has taken place. The social worker and their manager will coordinate and review such arrangements.
Feedback from Section 47 Enquiries:
The social worker is responsible for recording the outcome of the Section 47 Enquiries consistent with the requirements of the recording system. The outcome should be put on the child's record with a clear record of the discussions, authorised by the children's social care manager.
Notification, verbal or written, of the outcome of the enquiries, including an evaluation of the outcome for the child, should be given to all the agencies who have been significantly involved for their information and records.
The parents and children should be given feedback of the outcome of the S47 enquiry in particular in advance of any initial child protection conference that is convened. Issues affecting the communication with the parent and/or the child(ren) should be taken into account when deciding how best this should be achieved.
Information should be conveyed in an appropriate format for younger children and those people whose preferred language is not English
If there are ongoing criminal investigations, the content of the children's social worker's feedback should be agreed with the police.
Feedback about outcomes should be provided to non-professional referrers in a manner that respects the confidentiality and welfare of the child.Where the child concerned is living in a residential establishment which is subject to inspection, the relevant inspectorate should be informed.
Where the decision about the outcome of the Section 47 Enquiry is disputed:
Where Children's social care have concluded that an initial child protection conference is not required but professionals in other agencies remain seriously concerned about the safety of a child, these professionals should seek further discussion with the social worker, their manager and/or the nominated safeguarding children adviser. The concerns, discussion and any agreements made should be recorded in each agency's files.
If concerns remain, the professional should discuss with a designated/named/lead person or senior manager in their agency and the agency may formally request that Children's social care convene an initial child protection conference. Children's social care should convene a conference where one or more professionals, supported by a senior manager/named or designated professional requests one.
If the matter remains unresolved the Resolving Professional Disagreements (Escalation Procedure) should be used.
12. Timescales for Section 47 Enquiries
From when children's social care receive a referral or identify a concern of risk of significant harm to a child:
- The initial strategy discussion meeting which may instigate the Section 47 Enquiry must take place within three days;
- The multi-agency assessment taking place along with the Section 47 Enquiries must be completed within a maximum of 45 days of the original referral date with progress being reviewed by a children's social care manager regularly to avoid any unnecessary delay and to ensure that the safety of the child is reviewed effectively.
The maximum period of an enquiry from the strategy discussion/ meeting to the date of the initial child protection conference is 15 working days. In exceptional circumstances where more than one strategy discussion / meeting takes place the timescale remains as 15 working days from the strategy discussion / meeting which initiated the Section 47 Enquiries.
A full written record must be completed by each agency involved in a Section 47 Enquiry, using the required agency proforma, authorised and dated by the staff.
The responsible manager must countersign/authorise children's social care Section 47 recording and forms.
Practitioners should, wherever possible, retain rough notes in line with local retention of record procedures until the completion of anticipated legal proceedings.
At the completion of the enquiry, the social work manager should ensure that the concerns and outcome have been entered in the recording system including on the child's chronology and that other agencies have been informed.
Children's social care recording of enquiries should include:
- Agency checks; details of individuals and their designation contacted during the assessment;
- Content of contact cross-referenced with any specific forms used;
- Strategy discussion/meeting notes;
- Details of the enquiry;
- Body maps (where applicable);
- Assessment including identification of risks and how they may be managed;
- Decision making processes;
- Outcome/further action planned.
All agencies involved should ensure that records have been concluded and countersigned in line with agency policies and recording procedures.
All records should be checked for the correct spelling of names and any alias as well as correct dates of birth.