ARTICLES

Child protection is an area that many practices find challenging to address. Suzanne Creed, clinical risk education manager at Medical Protection, offers a clear guide to the Children First Act

The Children First Act 2015 places several statutory obligations on specific groups of professionals and on particular organisations providing services to children.¹ These are “mandated persons” and those who work in an organisation that is a “relevant service”.

Doctors, nurses and midwives working in general practice are mandated persons. General practice staff work in a relevant service that is “Any work or activity…which consists mainly of the person having access to, or contact with children in any hospital, hospice, health care centre or other centre which receives, treats or otherwise provides physical or mental health services to children.”¹

The Children First National Guidance for the Protection and Welfare of Children 2017 document provides information on the statutory obligations for those individuals and organisations under the Act. It also sets out the best practice procedures that should be in place for all organisations providing services to children.²

Professional obligations of a doctor

The Medical Council Guide to Professional Conduct and Ethics clearly outlines a doctor’s professional responsibility in relation to child protection.³ It states:

“You must be aware of and comply with the national guidelines and legislation for the protection of children, which state that the welfare of the child is of paramount importance.

If you believe or have reasonable grounds for suspecting that a child is being harmed, has been harmed, or is at risk of harm through sexual, physical, emotional abuse or neglect, you must report this to the appropriate authorities and/or the relevant agency without delay. You should inform the child’s parents or guardians of your intention to report your concerns taking into account that this may endanger you or the patient. Giving relevant information to appropriate authorities or statutory body for the protection of a child is a justifiable breach of confidentiality, provided that you follow the guidance in paragraph 31.2.”³

The guidance also outlines in paragraph 31.2 when disclosure is required by law. It states: “Where you know or have reasonable grounds for believing that a crime involving sexual assault or other violence has been committed against a child.”³ 

The Children First National Guidance for the Protection and Welfare of Children 2017 document describes the four main types of abuse and sets out the steps that should be taken to ensure that the child or young person is protected from harm. It also details the statutory responsibilities for mandated persons and organisations under the Children First Act 2015.

Guiding principles for suspected child abuse

• The safety and wellbeing of the child must take priority over concerns about adults against whom an allegation may be made.
• Reports of concerns should be made without delay to Tusla – the Child and Family Agency.

• If the child is in immediate danger and you cannot contact Tusla, you must contact the Gardaí without delay.
  
  

Factors predisposing to child neglect/abuse

There are common factors associated with neglect and child abuse:

• Parent/guardian

  Factors include drug/alcohol misuse, mental health, domestic violence, adolescent parents, missing appointments, reluctance to engage and lack of insight.

• Children

  Factors include age, gender, sexuality, mental health including deliberate self-harm, previous abuse, communication difficulty, human trafficking and acting as young carers.

• Community factors

  Cultural, ethnic or religious practices, female genital mutilation, forced/child brides and honour killings.

• Environmental factors:

  Poor housing, poverty and bullying. 

  There are four main types of child abuse:

• Neglect
• Emotional abuse
• Physical abuse
• Sexual abuse.

Tips to ensure compliance with Children First Act 2015

The following is a list of best practice procedures you should consider for your practice.

1. Nominate a child protection lead

The child protection lead will normally be a senior clinician.

2. Child protection risk assessment

A risk assessment is an exercise where the organisation examines all aspects of its service from a safeguarding perspective, to establish whether there are any practices or features of the service that have the potential to put children at risk. This does not assess general health and safety risks, such as slips, trips and falls – since these apply to adults as well as children, they should be covered by a practice health and safety risk assessment.

Your practice risk assessment should:

• Identify potential risks: how might children and young adults suffer abuse while using your service?
• Stratify risk: high/medium/low. This stratification considers the likelihood and consequences of abuse.
• Manage the risks.
• Review the controls implemented and actions undertaken to ensure effective mitigation of identified child protection risks.

   

  3. Develop and display a child safeguarding statement

  This is mandatory under the Children First Act 2015. The legislation states that this should have been displayed from March 2018 and updated every two years. The statement is an overview of the services being provided in your practice and the measures taken to protect children. It should identify “the principles and procedures to be observed in order to ensure, as far as practicable, that a child availing of the service is safe from harm”.²
  
  

  The child safeguarding statement includes an assessment of risk of harm to a child while using your service and specifies the procedures in place to manage any identified risks. Organisations are required to circulate it to all staff, to display it publicly and to make it available to members of the public upon request. You may choose to put the child safeguarding statement on your practice website and as a poster in your waiting room.
  
  

  Additional information on preparing a child safeguarding statement and undertaking a risk assessment is available from the Tusla (Child and Family Agency) website.⁴ 
  
  4. Practice child protection policy

  This policy should include:
  
  

• The aims and objectives of your practice
• A commitment to comply with legislation and professional guidance
• Details of the child protection lead, outlining roles and responsibilities
• The approach to reporting concerns and dealing with parents
• Information sharing, record keeping and confidentiality
• How to manage adults who disclose child abuse
• Allegations of abuse against staff and/or colleagues
• Staff recruitment
• Staff training

1. Formally nominate a child protection lead in your practice.
2. Undertake a written risk assessment.
3. Develop and publicly display a child protection safeguarding statement. This statement is mandatory and should have been in place since March 2018. The statement must be available to parents and guardians, Tusla and members of the public upon request.
4. Develop and make available your practice child protection policy.
5. Provide child protection training for all staff.
6. Undertake Garda vetting for all staff.

   This is a brief outline of what your child protection policy might address. The Tusla booklet Child Safeguarding: A Guide for Policy, Procedure and Practice explores these issues in detail.

5. Child protection training

Tusla has worked with the Department of Children and Youth Affairs (DCYA) and the HSE to develop a universal e-learning training programme, available on the Tusla website at tusla.ie, entitled Introduction to Children First. It has been written to support people of all backgrounds and experience in recognising concerns about children and reporting such concerns if they arise.

This 90-minute training programme is available to all practice staff, both clinicians and administrative staff, free of charge. The training includes an assessment and a certificate of satisfactory completion, and is valid for three years. Training practices may wish to confirm that GP registrars and medical students have undergone appropriate child protection training and Garda vetting prior to attending their practice.

6.Garda vetting

Garda vetting is mandatory for all staff who have access to or work with children or vulnerable adults. This includes both clinicians and administrative staff.

Garda vetting is the process by which the Garda National Vetting Bureau, on receipt of a request from a registered organisation, discloses details regarding all prosecutions and convictions in respect of an individual. Garda vetting is conducted on behalf of registered organisations only and is not conducted for individual persons on a personal basis.

The National Vetting Bureau (Children and Vulnerable Persons) Acts 2012 to 2016 provide a statutory basis for the vetting of persons carrying out relevant work with children or vulnerable persons.⁶ The Act also creates offences and penalties for persons who fail to comply with its provisions. 

The HSE has an excellent website addressing the frequently asked questions around child protection: see FAQ for HSE Contracted Services at hse.ie.

In the event of concern around possible child abuse you are strongly advised to contact the Medical Protection telephone advice line to speak with a medicolegal consultant.

References

1. Children First Act (2015)
2. Children First National Guidance for the Protection and Welfare of Children 2017
3. Medical Council, Guide to Professional Conduct and Ethics for Registered Medical Practitioners, 8th edition (2016)
4. Tusla, Publications and Forms, tusla.ie
5. Child Safeguarding, A Guide for Policy and Procedure and Practice
6. An Garda Siochána; National Vetting Bureau: https://vetting.garda.ie/