Child protection in the family planning setting
A. Gunstone (1), D. Kinn (2)
North Liverpool Primary Care Trust, Abacus Clinics for Contraception and
Reproductive Health, Liverpool, UK (1); St. Helens Primary Care Trust,
Reproductive Health Services, St Helens, UK (2)
Introduction: Recent deaths from long-term child abuse in the U.K.,
highlighted the need to ensure a robust system, acceptable to clients and staff,
for managing children perceived to be suffering, or at risk of, abuse. Our
clinics provide open access, confidential contraceptive services to a population
of 612,000 at 26 sites including 4 young people’s clinics, with a total annual
attendance of 59,000 of which 1,700 are 516yrs of age. If a minor discloses
abuse, physical, sexual or other, our strict confidentiality rules must be
broken and the case passed to the appropriate agencies. Luckily this is rare.
However, much more often, the situation is not clearcut; we are worried about a
young client’s situation past, present or future, or a perceived risk to
others, but do not feel that immediate referral is in their best interest.
Design & Methods: We developed procedures, in consultation with
experts in the field, to enable these children to be monitored and supported.
The case is discussed immediately with a senior clinician; the client is
informed of our concerns, and reliable contact arrangements are made, eg mobile
phone, school. Within 24hrs, a member of our in-house Child Protection
Supervision Group (CPSG), of experienced nurses and doctors, will be consulted,
also other agencies as necessary. All staff receive training to make them aware
that children suffering, or at risk of, abuse may attend our clinics, and are
informed of the new procedures with regular updating.
Results: The protocols are implemented when abuse is suspected. Each
clinic site holds a Child Protection Folder containing instructions to staff,
forms for detailing the concern and labels to be stapled to the inside of the
case notes. Labelling the notes alerts staff to previous concern and ensures
that these vulnerable clients are fast-tracked to consultation with a senior
clinician at each visit. A copy of the case notes with a completed form is sent
to the CPSG and securely filed when any necessary immediate action has been
taken. Cases are reviewed quarterly until the young person is no longer a
concern, or reaches 18yrs (19yrs if from vulnerable groups eg learning
disabilities, looked-after children) and is passed to adult services.
Conclusions: Robust and acceptable child protection systems can be
implemented within a confidential community family planning service.