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G102(P) Working together in 2018: how can we make child protection medical examinations work to safeguard children?

Aims To analyse the referrals for Child Protection Medical Examinations (CPMEs) for children from two urban boroughs, to seek to improve the referral framework, and outcomes for their children at risk. Methods 76 CPMEs completed in the year to September 2018 were reviewed, to identify the referral source, the abuse suspected and alleged perpetrator, previous involvement with children’s services, and unmet medical needs. Results Children’s Services received 38 of the 76 referrals from schools, 14 from social workers holding existing cases, 9 from police, 7 from immediate family, 6 from Health Professionals, and 2 from Nurseries. 57 referrals for CPMEs related to suspected physical abuse. The alleged perpetrator, where identified, was mother in 23 cases, father in 22, a parent’s partner in 3, and a childminder in 1. 9 referrals related to suspected neglect, 3 to trafficking,1 to possible FGM (sexual abuse referrals are usually seen elsewhere), and 6 were siblings of an index case. Domestic violence was identified in 30 cases. 53 children were previously known to Children’s services, 24 with Child Protection Plans, 19 as Children in Need, and Family Court involvement in 8 cases. Unmet medical needs were identified in 36 cases, with 14 related to development delay, 17 to the child’s mental health, and 10 further cases of unmet parental mental health needs. Conclusions Results are similar to our previous review of CPMEs in the 9 months preceding this study. School teachers remain key in reporting physical abuse. Referrals for CPMEs for children at risk of neglect remain under represented, and the extent of their unmet medical needs merits joint consideration by Health and Children’s Services, ideally prior to a Section 47 enquiry. Where a recommendation for CAMHS, adult mental health, or developmental assessments has been highlighted in a CPME, the facility to fast track these appointments for both children and parents, might contribute to the earlier identification of their vulnerabilities and the support they require, and also to their resilience in facing their safeguarding challenges.