Management of abuse

If there is considered to be a risk to a child, all health-care staff are under a legal obligation to notify the local authority child protection team, so that the risk can be assessed and any appropriate action taken. Sometimes, this duty to inform the local authority may involve a potential breach of confidentiality, as in respect of an adult psychiatric patient who is a parent. (This can lead to difficulties, so

PSYCHIATRY OF ADOLESCENCE

it is wise to discuss such matters within one's team or with a colleague or professional adviser.)

If there is immediate risk, the child can be received into foster care, or taken to a place of safety; sometimes this is with the agreement of the parents ('voluntary accommodation'); on other occasions, the local authority will apply to a magistrate under the Children Act.

Medical assessment of suspected cases of physical or sexual abuse should only be carried out by a senior paediatrician or child psychiatrist with relevant experience, because of the sensitive nature of this work and the diagnostic difficulties that may arise.

Social services departments are responsible for prevention and management, and keep a register of children at risk. This would be followed typically by a multidisciplinary case conference, attended by social workers and other professionals such as police, health visitor, GP, paediatrician, and child psychiatrist. Under the Children Act 1989, the child's interests receive priority over other considerations.

Close surveillance combined with family and individual psychotherapy may enable the family to remain intact, but in some cases it is necessary to remove the perpetrator to prison and/or take the abused child into care.

The tragic death of Victoria Climbie was followed by an inquiry (http://www. victoria-climbie-inquiry.org.uk/); among its recommendations was the establishment of a Children's Commissioner to oversee services and make sure that children's needs are included.

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