Child Protection 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.

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.

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.

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, seek and analyse available information in order to consider the welfare of the child and the level of risk posed;
• Decide whether enquiries under section 47 of the Children Act 1989 must be undertaken;
• Agree to undertake either a single or joint Social Care/Police investigation (S.47 Enquiries);
• Agree the conduct and timing of any criminal investigation.

Whether to make enquiries is a multi-agency decision and the strategy discussion should inform this decision.

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 and safeguard the child, and who will do what by when;
• Whether legal action is required.

Roles and responsibilities

Lead practitioners should convene the strategy discussion and make sure they:

• Consider the child's welfare and safety, including through speaking to the child, and identifying whether the child is suffering or likely to suffer significant harm;
• Decide 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 harm);
• Agree 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 in accordance with recording procedures;
• Follow up actions to make sure what was agreed gets done.

Health practitioners should:

• Advise about the appropriateness or otherwise of medical assessments (including a child protection medical assessment or child sexual assault assessment), 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.

The Police should:

Discuss the basis for any criminal investigation, including both reactive (where there is evidence to suggest a crime has been committed) and proactive (where further activity is required to establish if a crime has occurred), 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 where joint enquiries take place with the local authority children's social care leading for the section 47 enquires and assessment of the child's welfare.

If the child is in hospital, decisions should also be made about how to secure the safe discharge of the child.

Outcomes:

The plan made at the strategy discussion/meeting should reflect the requirement to convene an Initial Child Protection Conference within 15 working days of the strategy discussion at which it was decided to initiate the Section 47 Enquiry. When Children's Social Care have concluded that an Initial Child Protection Conference is not required but practitioners in other agencies remain seriously concerned about the safety of a child, these practitioners should seek further discussion with the Lead Practitioner, their manager and/or the designated safeguarding professional lead. The concerns, discussions and any agreements made should be recorded in each agency's files. This should be actioned within a timescale commensurate with the need to safeguard the child and in accordance with the Conflict Resolution Policy.

If the conclusion of the strategy discussion/meeting is that there is no cause to pursue the Section 47 Enquiry then consideration should be given to continuing a multi-agency assessment to meet the needs of the child for any Early Help support services or to provide family support services to them as a child in need.

See Working Together to Safeguard Children, Flowchart 5: Action Following a Strategy Meeting.

For information on electronic and digital recording of meetings see related guidance in the Child Protection Conferences Procedure, Membership of Child Protection Conference.

Local authority social workers should lead assessments under section 47 of the Children Act 1989. The police, health practitioners, teachers and school staff and other relevant practitioners should help the local authority in undertaking its enquiries.

The Lead Practitioner for section 47 enquiries should be a social worker.

Practitioners should work collaboratively and proactively with multi-agency practitioners to build an accurate and comprehensive understanding of the daily life of a child and their family to establish the likelihood of significant harm and any ongoing risks.

Lead practitioners should:

• Lead the assessment in accordance with the guidance Working Together to Safeguard Children;
• Carry out enquiries in a way that minimises distress for the child and family;
• See the child who is the subject of concern to ascertain their wishes and feelings, assess their understanding of their situation, assess their relationships and circumstances more broadly, and understand the child's experiences and interactions with others, especially where there are concerns of extra-familial harm;
• Explain to parents or carers the purpose, process and potential outcome of the enquiries and be prepared to answer questions openly, unless to do so would affect the safety and welfare of the child;
• Interview parents or carers and determine the wider social and environmental factors that might impact on them and their child, including extra-familial contexts;
• Systematically gather information about the child's and family's history;
• Analyse the findings of the assessment and evidence about what interventions are likely to be most effective with other relevant practitioners;
• Determine the child's needs and the level of risk of harm faced by the child to inform what help should be provided and act to provide that help;
• Follow the guidance set out in Achieving Best Evidence in Criminal Proceedings: Guidance on Interviewing Victims and Witnesses and Guidance on Using Special Measures where a decision has been made to undertake a joint interview of the child as part of any criminal investigation.

Health practitioners should:

Provide appropriate specialist assessments, for example, paediatric or forensic medical assessments. Physiotherapists, occupational therapists, speech and language therapists and/or child psychologists may be involved in specific assessments relating to the child's developmental progress. The lead health practitioner (e.g. GP, Paediatrician) may need to request and co-ordinate these assessments;

Ensure appropriate treatment and follow-up health concerns, such as administering missing vaccines.

The Police should:

• Help other organisations and agencies understand the reasons for concerns about the child's safety and welfare by sharing information and analysis;
• Decide whether or not police investigations reveal grounds for instigating criminal proceedings;
• Make available to other practitioners any other relevant information gathered or known to inform discussions about the child's welfare;
• Follow the guidance set out in Achieving Best Evidence in Criminal Proceedings: Guidance on Interviewing Victims and Witnesses and Guidance on Using Special Measures where a decision has been made to undertake a joint interview of the child as part of the criminal investigation.

All involved practitioners should:

• Contribute to the assessment as required, providing information and analysis about the child and family;
• Consider whether a joint enquiry or investigation team may need to speak to a child victim without the knowledge of the parent or carers;
• Approach the work with parents and carers in line with the principles in chapter 1 of Working Together to Safeguard Children;
• Seek advice and guidance as required and in line with local practice.

The National Multi-agency Practice Standards for Child Protection provide that:

Practitioners should:

• Satisfy themselves that conclusions about the likelihood of significant harm give sufficient weight to the views, experiences, and concerns of those who know the child and/or parents well, including relatives who are protective of the child, and other relevant practitioners;
• Share their thinking and proposed recommendations with other practitioners who hold relevant information and insight into the child and adults involved with the child;
• Comment, challenge, and jointly deliberate, before making a final decision about the likelihood of significant harm;
• Together with other agencies, clarify what family help from multiagency partners is necessary to reduce the likelihood of significant harm and maintain reasonable care for the children. They should seek assurance that this resource is available and of sufficient skill and intensity;
• Remain alert to changes in circumstances for the child and family and respond as new information comes to light that needs to be reflected in the child protection plan;
• Reflect on the proposed protection plan and consider adjustments to strengthen the protection plan. The protection plan should be specific, achievable, and relevant to the likelihood of significant harm and the context in which it is occurring.

The assessment of risk will:

• Identify the cause for concern, its seriousness, any recurring events and the vulnerability and resilience of the child;
• Evaluate the strengths, including the 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 and how;
• Consider the capacity of the parents and wider family and social networks to safeguard and promote the child's welfare - this should include both parents, any other carers, such as grandparents, and the partners of the parents;
• Consider risk factors that may suggest a higher level of vulnerability in the family and risk of significant harm such as parental mental health difficulties, parental substance misuse, and domestic abuse or combinations of these;
• Determine the level of intervention required to improve the outcome for the child to be safeguarded in the immediate, interim and longer term.

See: Working Together to Safeguard Children, Flowchart 4: Action Taken for an Assessment of a Child under the Children Act 1989.

You should approach the work with parents and carers in line with the principles of a child-centred approach within a whole family focus set out in Working Together to Safeguard Children.

The Child

Practitioners should take care to ensure that children know what is being discussed about them and their family where this is appropriate. They should ask children what they would like to happen and what they think would help them and their family to reduce the likelihood of significant harm, including where harm is taking place in contexts beyond the family home. Practitioners should listen to what children tell them.

Children who are the subject of Section 47 Enquiries should always be seen and communicated with alone by the social worker. The initial discussions with the child should be conducted in a way that minimises distress to them and maximises the likelihood that they will provide accurate and complete information, avoiding leading or suggestive questions. 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 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 (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 Lead Practitioner or their 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 Lead Practitioner, 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

Practitioners should engage parents and the family network, as appropriate, in the discussions, recognising previous involvement with agencies and services may influence how they engage. Practitioners should encourage parents and families to express what support would help them to reduce significant harm.

Practitioners should thoroughly explore the significance of the adults in contact with the child and their family or individual histories. They should pay particular attention to any serious criminal convictions, previous allegations of child abuse, domestic abuse or impulsive violent behaviour, restrictions on contact with children or involvement with children subject to child protection plans or care proceedings.

Practitioners should explain clearly to parents and the family network the implications of the threshold that has been reached for section 47 enquiries, the initial child protection conference, and any ongoing child protection plan (including that this threshold may lead to pre-proceedings, should the likelihood of significant harm not reduce). Practitioners should do everything they can to ensure that parents and the family network understand and can engage purposefully with the enquiries and any protection plan.

If a parent has a specific communication difficulty or English is not their first language, an interpreter should be provided.

The Lead Practitioner 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 should be involved at the earliest opportunity unless to do so would jeopardise a police investigation or place the child at risk of harm. 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 a police investigation or place the child at risk of harm.

The assessment should include both parents, any other carers such as grandparents and the partners of the parents, as applicable.

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.

Strategy Discussions / Meetings must consider, in consultation with a Paediatrician on call for child protection the appropriateness and the timing of a child protection medical assessment.

Consideration of a child protection medical assessment is an essential component of a child protection investigation. It is important to recognise however, that the child protection medical investigation is only a part of the overall multi-agency assessment to assess the safety and well-being of a CYP and other agencies should not use this as the sole determinant as to whether they should be involved.

HR protection medical 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 if necessary, 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.

The child protection medical assessment has a number of aims:

• To identify the child's health needs;
• To consider the physical and psychological sequel of such abuse;
• To give an opinion from a medical perspective on 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 child protection medical 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.

CSA/CSE

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 in the Contacts section of the resource library, Organising a Medical for guidance on arranging child protection medicals.

Consent:

Children and young people should be always be informed in an age appropriate way, about the examination taking into account their developmental, communication and information needs.

Consent or authorisation to a medical assessment can be given by:

• A child of 16 years and older;
• A child or young person who has the maturity and understanding to make the decision (Gillick competency/Fraser guidelines);
• 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;
• Any person with parental responsibility, providing they have the capacity to do so;
• A court when a direction has been attached to an order obtained under the Children Act.
• The local authority when the child is the subject of a full or interim care order (though the parent should be informed) Paediatricians should note that an emergency protection order (EPO) or child protection order does not give the local authority full PR. When applying for an EPO, it’s important to make sure that the local authority legal team asks the judge to make a direction about any anticipated medical assessment and examination. In these circumstances, it is the direction that gives authority to examine, not someone’s signature on a consent form.

Consent should be in writing where possible, but you can rely on oral consent from a parent/carer or agency in certain circumstances; for example, by a telephone conversation if waiting for written consent would delay examination or treatment of a child or young person. If telephone consent is the only option, it is good practice to ask an independent adult to sign to confirm they witnessed the conversation (e.g. police, social worker) and the documentation is a true reflection of this. All discussions must be recorded in the child or young person’s medical records.

Consent should be taken by the examining/treating doctor; it is not sufficient to receive a parental signature via a third party such as a social worker.

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:

Once it has been agreed at a strategy discussion that a child protection medical is needed, please see the following chart for how to organise the medical, Organising a Medical. It is best practice that a child protection medical assessment for physical injury is carried out within 24 hours, however there are benefits to the assessment taking place within normal working hours (including access to medical photography and senior professionals with dedicated time to do the assessment) and this will need to be considered alongside safety plans and risks of losing evidence (e.g. visualising bruises).

In the course of Section 47 Enquiries, appropriately trained and experienced practitioners must undertake all child protection 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 and give details as to who provided that opinion (Name and Grade). 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 written provisional report (in line with RCPCH guidance) which gives the professional medical opinion regarding the likelihood of abuse based on the history and clinical findings is provided to the social worker (and police officer if present). This is provided at the time of the child protection medical assessment though it may contain a proviso that more information may be required, and may be amended following the results of any investigations undertaken or following the case being discussed with colleagues

In Nottinghamshire County, following ALL child protection medicals, there should always be a discussion between the Team Manager and the Children’s Service Manager to decide the next steps. In Nottingham City, a conversation between the Team manager and Children’s Service Manager should take place if the outcome of the medical is felt to be NAI/more likely than not NAI. 

If it is a joint assessment, this summary may be provided to the police by the Social Worker with prior agreement from the medical professional.

A comprehensive typed written report with a full professional opinion is emailed securely to social care and police (if involved), as soon as possible but within 5 working days of the child or young person being seen, or sooner if needed, such as for a court hearing. Additional information such as investigation results will be sent at a later date as received as addendum reports with an opinion about whether this impacts on the previous opinion provided.

If the initial child protection medical assessment requires further investigations or admission to hospital, then clear arrangements should be made and documented regarding who will provide the opinion and report writing in each case.

If the clinician becomes aware of significant new information particularly if this changes the opinion given in the provisional report they should make contact with the social worker or social work manager as a matter of urgency to discuss this, rather than use the full report to communicate this. This discussion should involve considering whether a further multi-agency strategy meeting is indicated to fully understand the possible implications of new information on the child and the multi-agency investigation.

Children subject to repeat child protection medicals

Following a recent case study and audit in relation to a sibling group who had been subject to repeat child protection medicals in a relatively short time period, we are introducing a new process. Please note the steps to follow below and please ensure your entire staff group are aware of this new process.

• The dates and outcomes of the previous child protection medicals should always be considered as part of the strategy discussion. This should include consideration of whether a further child protection medical is actually required in order for a multi agency plan to be made to protect the child from harm, particularly if a previous medical found on the balance of probability non accidental injury was most likely. If it is agreed that a child protection medical is appropriate and the paediatrician performing the child protection medical is not part of this strategy discussion, then they should be updated on this information prior to the medical;
• The Consultant Paediatrician performing the child protection medical assessment, or supervising a paediatrician in training, should always review the reports of any previous child protection medicals and provide a summary of the findings within their child protection medical report. This may include information from any peer review which occurred following the previous child protection medicals. There should also be a review of any pertinent medical information available. It should be remembered that the examining doctor can only provide information on what is available to them within their organisation or following information sharing from health colleagues during the strategy discussion. It is therefore important for any gaps in the wider health information to be gathered by social care as part of the initial assessment. The examining paediatrician should include and reflect on the information they have  as part of the summary and conclusion including their view of the current level of risk / concern. It may be necessary to request the support of the named doctor in this particularly if there is uncertainty or professional disagreement about the outcome of previous medicals, or there have been a number of child protection medicals;
• Where two child protection medicals with concerns regarding physical harm take place within close proximity, for example, within 3 months of each other, or there have been three child protection medicals within 12 months, the Team Manager must discuss the child with the Children’s Service Manager (CSM). These timescales are not prescriptive and professional judgement should be used by the team manager to decide when this discussion should be requested;
• In this meeting the Team Manager and Service Manager should review the information and the medical findings, alongside any other concerns in order to determine the next course of action. Achronology should be compiled by the social worker for the meeting with the CSM, with dates and outcomes of all medicals including details of injuries, marks and bruising. This should be presented alongside the report from the most recent child protection medical assessment.

Sharing of reports

Where can the report be shared?

Caption: Sharing of reports

	Decision at the Strategy Meeting when the medical examination was requested
Report can be shared with:	Section 47 Single Agency	Section 47Joint Agency
GP (for the CYP)	Yes	Yes
CYP’s own Paediatrician (if involved)	Yes	Yes
Social Care (for the involved locality)	Yes	Yes
Police (investigating force)	Data Protection Office	Yes
If, for example, an investigation was initially single agency but later information led to Police seeking to prosecute, copies of the report should be requested via the Data Protection Office as standard.
Other agency (including education)	Data Protection Office	Data Protection Office
Family / CYP themselves	Data Protection Office	Data Protection Office
Court (as the report may need redacting or updating before it can be used in open court)	Contact author via NHS trust	Contact author via NHS trust
Information/records that must only come via Data Protection Office (even if Police or Social Care are the requesting agency)
Medical Examination record/report NOT carried out under section 47 enquiries (e.g. seen in Emergency Department and treated prior to safeguarding concerns emerging or where no Strategy Meeting was held) Any original notes (including handwritten ‘NAI’ proforma (Except for the handwritten summary given on the day of the examination), clinic or inpatient notes, electronic file notes and documentation of phone consultations) Any images or videos (including X-rays, patient photography, colposcopy videos) Formal statements for court or solicitors
Sherwood Forest Hospitals	sfh-tr.sar@nhs.net
Nottingham University Hospitals (including EMCYPSAS)	nuhnt.dataprotectionadminoffice@nhs.net
Doncaster and Bassetlaw	dbth.casenoterelease@nhs.net

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.

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.

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 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.

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.

Please also see: Early Years Existing Injuries Pack and Assessment of Subconjunctival Haemorrhage (SCH) in Infants.

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: Guidance on interviewing victims and witnesses, and guidance on using special measures (Ministry of Justice). All events up to the time of the video interview must be fully recorded. Consideration of the use of video-recorded evidence should take into account situations where the child has been subject to abuse using recording equipment. Achieving Best Evidence (ABE) promotes a strong victim-centred and trauma-informed approach throughout the guidance. It covers the interview process for child and adult victims and witnesses during a criminal investigation, the pre-trial preparation process and the support available to witnesses in court.

Visually recorded interviews serve two primary purposes:

• Evidence gathering for criminal proceedings;
• Examination in chief of a child witness.

Relevant information from this process can also be used to inform Section 47 Enquiries, subsequent civil childcare proceedings or disciplinary proceedings against adults, where allegations have been made.

The Lead Practitioner (social worker) is responsible for deciding what action to take and how to proceed following section 47 enquiries. They should make these decisions based on multi-agency discussions informed by the voice of the child.

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).

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.

Where Concerns of Significant Harm are Not Substantiated

Lead practitioners should:

• Discuss the case with the child, parents and other practitioners and be prepared to answer questions openly and be clear on next steps;
• Discuss whether support from any services may be helpful and help secure it;
• Consider whether the child's health and development should be re-assessed regularly against specific objectives and decide who has responsibility for doing this; and
• Discuss with the family whether they wish to be referred to a family group decision-making forum, such as a family group conference, to determine ongoing support for the child and family.

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;
• Review the impact of services delivered as agreed in the plan;
• Approach the work with parents and carers in line with the principles of a child-centred approach within a whole family focus set out in chapter 1 of Working Together to Safeguard Children;
• Seek advice and guidance as required and in line with local practice guidance; and
• Consider the plans for ongoing assessment and reviewing the child's circumstances.

Arrangements should be noted for future referrals, if appropriate.

Where Concerns of Significant Harm are Substantiated and the Child is Judged to be Suffering, or Likely to Suffer, Significant Harm:

Lead practitioners should: 

• Convene an initial child protection conference. The timing of this conference should depend on the urgency of the case and response 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 which practitioners with specialist knowledge or relevant professional disciplines should be invited to participate so that the plan will meet the child's needs;
• Seek to communicate the outcome and rationale to the referring practitioner or agency, and give particular consideration to whether they should be included in the child protection conference;
• Ensure that the child and their parents understand the purpose of the conference and who will attend. Parents should be given appropriate information to support their participation in the conference;
• Help prepare the child if they are 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 practitioners should:

• Be sufficiently skilled and experienced to prepare for and engage with the child protection conference, and able to critically assess and challenge their own and others' input;
• 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;
• Offer clear analysis based on their perspective;
• Consider, in conjunction with the police and the appointed conference Chair, whether the report can and should be shared with the parents and if so when;
• Approach the work with parents and carers in line with the principles of a child-centred approach within a whole family focus set out in chapter 1 of Working Together to Safeguard Children;
• Attend the conference and take part in decision making when invited;
• Seek advice and guidance as required and in line with local practice guidance.

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 Lead Practitioner and their manager will coordinate and review such arrangements.

Feedback from Section 47 Enquiries:

The Lead Practitioner 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 electronic 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 of sufficient age and appropriate level of understanding should be given feedback of the outcome, in particular in advance of any initial child conference that is convened. This 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 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:

If local authority Children's Social Care decides not to proceed with a child protection conference, then other practitioners involved with the child and family have the right to request that local authority children's social care convene a conference if they have serious concerns that a child's welfare may not be adequately safeguarded. See Complaints in Relation to Child Protection Conference.

The speed with which an assessment is carried out after a child's case has been referred into the local authority Children's Social Care should be determined by the needs of the individual child and the nature and level of any risk of harm they face. This will require judgements to be made by a social work qualified Practice Supervisor or manager on each individual case. Adult assessments, for example, parent carer or non-parent carer assessments, should also be carried out in a timely manner.

The timescale for the assessment to reach a decision on the next steps should be based upon the needs of the individual child, consistent with the local protocol and no longer than 45 working days from the point of referral into the local authority Children's Social Care. If, in discussion with a child and their family and other practitioners, an assessment exceeds 45 working days, the Lead Practitioner should record the reasons for exceeding the time limit. In some cases, the needs of the child will mean that a quick assessment will be required. In all cases, as practitioners identify needs during the assessment, they do not need to wait until the assessment concludes before providing support or commissioning services to support the child and their family.

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 Lead Practitioner or 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;
• 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.

Section 3 in Working Together to Safeguard Children sets out national multi-agency practice standards for child protection for all practitioners working in services and settings who come into contact with children who may be suffering or have suffered significant harm within or outside the home.

Local safeguarding partners need to ensure all practitioners are supported to be able to achieve the national multi-agency practice standards for child protection, including through:

• An unrelenting focus on protection and the best outcomes for children;
• Creating learning cultures in which practitioners stay up to date as new evidence of best practice emerges;
• Creating an environment in which it is safe to challenge, including assumptions that relate to ethnicity, sex, disability, and sexuality.

A: Recognising actual or likely significant harm for all practitioners

• Practitioners are alert to potential indicators of abuse, neglect, and exploitation, and listen carefully to what a child says, how they behave, and observes how they communicate if non-verbal (due to age, special needs and/or disabilities, or if unwilling to communicate). Practitioners will try to understand the child's personal experiences and observe and record any concerns;
• Practitioners communicate in a way that is appropriate to the child's age and level of understanding and use evidence-based practice tools for engaging with children, including those with special educational needs and disabilities;
• When practitioners have concerns or information about a child that may indicate a child is suffering or likely to suffer significant harm, they share them with relevant practitioners and escalate them if necessary, using the referral or escalation procedure in place within their local multi-agency safeguarding arrangements. They update colleagues when they receive relevant new information;
• Practitioners never assume that information has already been shared by another professional or family member and always remain open to changing their views about the likelihood of significant harm.

B: Section 47 enquiries, child protection conferences and child protection plans

• Practitioners are aware of the limits and strengths of their personal expertise and agency remit. They work collaboratively and proactively with multi-agency practitioners to build an accurate and comprehensive understanding of the daily life of a child and their family to establish the likelihood of significant harm and any ongoing risks. Practitioners respect the opinions, knowledge and skills of multi-agency colleagues and engage constructively in their challenge;
• Practitioners have an applied understanding of what constitutes a child suffering actual or likely significant harm. They consider the severity, duration and frequency of any abuse, degree of threat, coercion, or cruelty, the significance of others in the child's world, including all adults and children in contact with the child (this can include those within the immediate and wider family and those in contexts beyond the family, including online), and the cumulative impact of adverse events; Practitioners take care to ensure that children know what is being discussed about them and their family where this is appropriate. They ask children what they would like to happen and what they think would help them and their family to reduce the likelihood of significant harm, including where harm is taking place in contexts beyond the family home. Practitioners listen to what children tell them;
• Practitioners engage parents and the family network, as appropriate, in the discussions, recognising previous involvement with agencies and services may influence how they engage. Practitioners encourage parents and families to express what support would help them to reduce significant harm;
• Practitioners thoroughly explore the significance of the adults in contact with the child and their family or individual histories. They should pay particular attention to any serious criminal convictions, previous allegations of child abuse, domestic abuse or impulsive violent behaviour, restrictions on contact with children or involvement with children subject to child protection plans or care proceedings;
• Practitioners satisfy themselves that conclusions about the likelihood of significant harm give sufficient weight to the views, experiences, and concerns of those who know the child and/or parents well, including relatives who are protective of the child, and other relevant practitioners;
• Practitioners share their thinking and proposed recommendations with other practitioners who hold relevant information and insight into the child and adults involved with the child. Practitioners comment, challenge, and jointly deliberate, before making a final decision about the likelihood of significant harm;
• Together with other agencies, practitioners clarify what family help from multi- agency partners is necessary to reduce the likelihood of significant harm and maintain reasonable care for the children. They seek assurance that this resource is available and of sufficient skill and intensity;
• Practitioners explain clearly to parents and the family network the implications of the threshold that has been reached for section 47 enquiries, the initial child protection conference, and any ongoing child protection plan (including that this threshold may lead to pre-proceedings, should the likelihood of significant harm not reduce). Practitioners do everything they can to ensure that parents and the family network understand and can engage purposefully with the enquiries and any protection plan;
• Practitioners remain alert to changes in circumstances for the child and family and respond as new information comes to light that needs to be reflected in the child protection plan;
• Practitioners reflect on the proposed protection plan and consider adjustments to strengthen the protection plan. The protection plan is specific, achievable, and relevant to the likelihood of significant harm and the context in which it is occurring.

C: Discharging the child protection plan

• Practitioners work as part of a multi-agency team to create lasting change for families and ensure the child, parents and family network know that further help and support is available if needed or further concerns arise;
• Following a decision to discharge a child protection plan, practitioners ensure that appropriate support is in place for the child and family and respond to changing circumstances and new information;
• Where a child becomes looked after, practitioners ensure that this is well planned and that the child, parents and family network are appropriately supported. Ongoing need is monitored as part of care planning.

See also: Children's social care: national framework - Statutory guidance which sets out the principles behind children's social care, its purpose, factors enabling good practice and what it should achieve.

Referrals Procedure

Assessment Procedure

Information Sharing Procedure

Birth Protection Plan - When The Baby Is Going To Be Removed

Birth Protection Plan - Discharge Home

Brusing in Babies Flowchart

Assessment of Subconjunctival Haemorrhage (SCH) in Infants