3.5 Section 46 Enquiries and Core Assessment

Children in Need of Immediate Protection before Fully Assessing Risk of Harm, Statutory Framework, confers a duty on Social Services that where a child is:

• Subject to Police Protection; or
• They have reasonable cause to suspect a child is suffering or is likely to suffer Significant Harm.

Where enquiries are being made Social Services should:

• Obtain access to him/her or ensure access is obtained by an authorised person;
• The Children and Young Persons Act 2001 supports the best practice so that for the purposes of making a determination as to what action to take the Department shall, where possible:
  • Ascertain the child’s wishes and feelings about such action; and
  • Give due consideration to the child’s wishes and feelings.

The relevant manager in Social Services must ensure that Section 46 Enquiries are initiated when:

• A referral has been received that meets the criteria for immediate enquiries under Section 46, i.e. that a child is suffering or likely to suffer Significant Harm;
• Another child in the family has died or has been seriously injured and abuse is suspected – see also Serious Case Reviews Procedure and Child Death Overview Panel Procedure;
• An Initial Assessment of a Child in Need identifies that the child is suffering or is likely to suffer Significant Harm;
• During the process of a Core Assessment for a child in need concerns arise that the child is suffering or is likely to suffer Significant Harm.

Once it has been decided that a Section 46 Enquiry is required, the manager should ensure that:

• Checks are carried out with all agencies in order to ascertain who might have relevant information to contribute to a Strategy Discussion – see Strategy Discussions/Meetings Procedure;
• The first Strategy Discussion takes place within 24 hours.

2.1

Overview

2.2

Joint Agency Enquiries

A joint enquiry must always take place when there is an allegation or reasonable suspicion that one of the criminal offences below has been committed:

• Any suspected sexual abuse committed against a child aged up to eighteen years, except in situations of stranger abuse;
• Serious neglect or ill-treatment or emotional harm;
• Serious physical abuse to a child aged up to eighteen years old; this includes murder, manslaughter, any assault involving actual or grievous bodily harm, repeated assaults involving minor injury;
• Allegations involving organised or institutional abuse – see also Organised and Complex Abuse Procedure;
• Allegations which involve unusual circumstances, such as the presentation of bizarre behavioural/medical conditions including suspected illness induced or fabricated by carers with Parental Responsibility – see also see Fabricated or Induced Illness Procedure;
• Allegations relating to the forced marriage of a child – see Forced Marriage Procedure;
• Allegations against professionals who work with children – see Allegations of Abuse made Against a Person who Works with Children Procedure;
• Adults who are accessing indecent images of children who have regular direct contact with the children – see also Child Abuse Images and the Internet Procedure.

A joint enquiry must be considered in cases of:

• Minor injuries to a child subject to a Child Protection Plan or Looked After;
• Injury to a pre-mobile child.

For other cases of minor injury the following factors (where known) must be considered in determining the seriousness of the allegation or concern and, therefore, whether the threshold for a joint investigation has been met:

• The vulnerability of the child (including age, impairment);
• Any previous history of minor injuries;
• The intent of the assault;
• The use of a weapon;
• Previous concerns from a caring agency;
• The consistency with and clarity or credibility of the child’s accounts of the injuries;
• Other predisposing factors about the alleged perpetrator, e.g. criminal convictions, alcohol/drug misuse, mental health difficulties and Domestic Abuse.

2.3

Social Services Single Agency Enquiries

The criteria for single agency enquiries are where the available evidence suggests:

• Emotional abuse alone;
• Physical abuse resulting in minimal or no injury (except pre-mobile babies where a joint enquiry should be considered);
• Neglect insufficient for prosecution;
• Over-sexualised behaviour of a child where there are no other concerning features.

2.4

Police Single Agency Enquiries

These will usually be appropriate where:

• An adult makes an allegation about abuse in childhood;
• The alleged offender is not known to the child or the child’s family (i.e. stranger abuse). In this situation Social Services must be made aware of the investigation and a joint decision made by the first line managers in each agency as to whether the child’s needs should be assessed.

The Core Assessment process /Section 46 Enquiries should always:

• Be carried out in such a way that distress to the child is minimised;
• Involve separate interviews with the child who is the subject of concern, and interviews with parents and/or care givers, and observation of the interactions between parents and children;
• A child who is competent to take the decision can decide that they do not wish the parent to be involved and exceptionally, it may be agreed between Social Services and the Police that, in order to ensure the best possible evidence, it may be necessary to speak to a suspected child victim without the knowledge of the parent or the care giver. If parental consent for an interview is refused, the team manager in Social Services must be immediately informed and legal advice sought as a matter of urgency;
• Include other children in the family being seen/considered for interview;
• Treat families sensitively and with respect;
• Use the Framework for the Assessment of Children in Need and their Families to collect and analyse information and before completion cover all dimensions in the Assessment Framework;
• Give consideration to conducting interviews with all those who are personally or professionally connected with the child, and/or their parents and care givers;
• Ensure a commissioned interpreter is provided where a child or parent speaks a language other than that spoken by the interviewer. Wherever possible, this interpreter should be trained or briefed in safeguarding issues. See Use of Interpreters, Signers or Others with Communication Skills Procedure;
• Ensure children and parents with disabilities are provided with help with communication as required;
• Use alternative means of understanding the child’s perspective, including observation if a child is unable to take part in an interview because of age or understanding;
• Avoid using leading or suggestive communication where possible, although it must be recognised that some communication systems used by children with disabilities are leading in nature. This should not prevent the child’s views being ascertained;
• At all stages of the enquiry the child’s views, wishes and feelings should be ascertained and recorded.

4.1

Overview

A medical assessment should always be considered when there is disclosure or suspicion of any form of Physical Abuse, Sexual Abuse or Neglect. Additional considerations are the need to:

• Provide reassurance for the child and family where appropriate;
• Secure forensic evidence;
• Obtain medical documentation.

A Forensic Examination does not only refer to an examination where forensic samples are collected: The RCPCH and Association of Forensic Examiners define a Forensic Examination as ‘Any examination when a child has made a disclosure of sexual abuse or the referring agency  suspects sexual abuse has occurred’ (This applies to the acute or historic situation; both sexes).

4.2

Consent for Medical Examination or Medical Treatment

The following may give consent to a medical examination:

• A child of sufficient age and understanding (often referred to as Fraser Competent). This should generally be assessed by the doctor with advice from others as required. A young person aged sixteen or seventeen has an explicit right to provide consent to surgical, medical or dental treatment and unless grounds exist for doubting their mental health no further consent is required;
• Any person with Parental Responsibility;
• Social Services when the child is subject of a Care Order (although the parent/carer should be informed);
• Social Services when the child is Accommodated and the parent/carers have abandoned the child or are physically or mentally unable to give such authority. When a parent or carer has given general consent authorising medical treatment for the child legal advice must be taken as to whether this provides consent for a medical assessment for child protection purposes;
• The High Bailiff has inherent jurisdiction;
• A Family Proceedings Court as part of a direction attached to an Emergency Protection Order, an Interim Care Order or a Child Assessment Order.

Where circumstances do not allow permission to be obtained and the child needs emergency treatment then the medical practitioner may:

• Decide to proceed without consent;
• Regard the child to be of an age and level of understanding to give her/his own consent.

4.3

The Process of Medical Examination

In all cases of suspected sexual abuse an appropriate examination should be carried out in accordance with best practice in order to secure forensic evidence. GPs must not perform a detailed examination. In such cases:

• Examinations are carried out by a forensically trained Force Medical Examiner (FME). (Best practice guidance is available from the Royal College of Paediatrics and Association of Police Surgeons Child Health Guidelines (UK))  It may be necessary for younger children to have a joint examination with a paediatrician present, led by the FME;
• The police officer leading the enquiry will ensure that doctors are briefed and possession is taken of evidential items;
• Single examinations will only be undertaken if the person has the requisite skills and equipment;
• Single examination by an FME should preferably only be undertaken on older children (at least 10 years or older) and this will usually be in the case of acute (recent) sexual abuse or alleged rape;
• The FME (or paediatrician if involved in a Strategy Meeting) or following a joint examination has the discretion to recommend that a child is referred to a recognised UK sexual abuse centre. This can be for initial examination or for second opinion. The circumstances will vary on the Island depending on the availability and the experience of the FME and the paediatrician;
• It is acknowledged that no FME or paediatrician on the Isle of Man will be able to undertake colposcopy examination and this will influence the decision regarding examination at a UK centre;
• The need for a specialist examination by a child psychiatrist or psychologist should be considered.

4.4

Recording the Medical Examination

The report should include:

• Date, time and place of examination;
• Those present;
• Who gave consent and how (child/parent written/verbal);
• A verbatim report of the carer’s and child’s spontaneous accounts of injuries and concerns noting any discrepancies or changes in account;
• Documentary findings in both words and diagrams;
• Site, size, shape and, where possible, age of any marks or bruises;
• Other findings relevant to the child, e.g. squint, hearing problems, learning or speech problems;
• Confirmation of the child’s developmental progress (especially important in cases of neglect);
• Time the examination ended;
• A medical opinion of the likely cause of any injury or harm.

6.1

Outcomes

Section 46 enquiries will result in one of the following outcomes:

• Concerns not substantiated;
• Concerns substantiated but the child is not judged to be at continuing risk of Significant Harm;
• Concerns substantiated and the child is judged to be at continuing risk of Significant Harm.

6.2

Action where Concerns NOT Substantiated

Where concerns about the child being at risk of or suffering Significant Harm are not substantiated:

• The Core Assessment should be completed;
• A Child in Need Meeting should be held in order to consider with the family what support and/or services may be helpful;
• In some cases, concerns may remain about Significant Harm, despite there being no real evidence. It may be appropriate to put in place an arrangement to monitor the child’s welfare, but this should never be used as a means of deferring or avoiding difficult decisions. Where it has been decided that monitoring is required:
  • The purpose of monitoring should be clear – what is being monitored, why, in what way and by whom;
  • Parents should be informed about the nature of any on-going concern;
  • A date should be set for a discussion or meeting to review the monitoring arrangements.
• At this stage it may be appropriate to hold a Family Support Meeting to engage the parents and wider family group (as appropriate) in developing and implementing a Child in Need Plan.

6.3

Concerns are Substantiated but Child NOT at Risk of Significant Harm

Additionally, a Child Protection Conference may not be required in the following circumstances:

• The family’s circumstances have changed, e.g. the perpetrator of the abuse has permanently left the house and does not have contact with the child;
• Where Significant Harm was incurred as a result of an isolated abusive incident unlikely to occur again, e.g. abuse by a stranger;
• The agencies most involved judge that parent or care givers, or members of the child’s wider family, are willing and able to co-operate with actions to ensure the child’s safety and welfare. This judgement must be based on a soundly based assessment of the likelihood of successful intervention, based on clear evidence and mindful of the dangers of misplaced professional optimism.

6.4

Concerns Substantiated and Child at Risk of Significant Harm

Where concerns are substantiated and the child is judged to be at continuing risk of Significant Harm:

• In all situations where a child is judged to be at continuing risk of harm, Social Services must convene a Child Protection Conference;
• Where risk of harm is immediate the steps outlined in Action to be taken following a Referral to Social Services Procedure, Information Gathering and Sharing to be followed after the initial decision has been made, should be followed before a Child Protection Conference is convened;
• Unless there is some legal protection or a contingency plan in place where a child has become ‘looked after’ as a result of child protection concerns, an Initial Child Protection Conference will be required to gather information to inform planning to make sure that the ‘safety net’ is based on sound information and consideration of the facts.

Feedback on all child protection enquiries, whatever their outcome, will be provided by the social worker to:

• Their line manager;
• The child(ren) where appropriate;
• Parents and/or carers who will receive a copy of the ‘Record of Outcome of Section 46 Enquiries’ and Core Assessment when completed;
• Professionals who have contributed to the enquiries but who are not likely to have ongoing involvement with the child and family. They should receive notification of the outcome of enquiries;
• Professionals who were involved in the enquiries and who have ongoing involvement with the child and family. They should receive a copy of the ‘Record of Outcome of Section 46 Enquiries’ and a copy of the Core Assessment;
• If consulted during the Child Protection Enquiry, the Child Care Co-ordinator should receive feedback on the outcome.

7.1

Communicating with Children through the Process

Summary of the principal implications from research for practitioners undertaking in-depth interviews

• A child’s free account is preferable to answers obtained from specific questions, because it is likely to be fuller and more accurate;
• If direct questions are used, they should not be leading in type, repeated frequently during the interview, or associated with any other type of pressure from the professional. They should be followed by open ended questions or invitations to the child to say more;
• Practitioners should avoid bias and supposition;
• Interviews should normally be planned in advance. This enables clear identification of the purpose of the interview;
• It is useful to prepare children for in-depth interviews so that they know what to expect and in order to involve them in the process;
• In-depth interviews should normally have an introductory rapport building phase;
• A flexibly employed structure to the session is useful;
• Interviews should be recorded carefully in the most appropriate way for the individual circumstances;
• The practitioner should remember that false or erroneous accounts can emanate from children, adult carers or from professional practice;
• Any interviews with children should be based on established principles of professional good practice;
• It is essential to listen to and understand the child;
• It is essential to convey genuine empathic concern;
• It is essential to convey the view that it is the child who is the expert, not the professional;
• It is easier for practitioners to develop and maintain the qualities and competencies outlined above if they work within an environment that encourages critical review of practice if they seek frequent updates on research findings and consensus statements, and if they have the opportunities for continuing professional development.