Suspicious or unclear hospital admission or discharge - advice
This advice provides information regarding the suspicious or unclear hospital admission or discharge of a child who is involved with child protection.
Document ID number 2424, version 2, 1 March 2016.
Detailed child protection assessment is required when a child with whom child protection is involved is admitted to hospital with a suspicious or unclear condition.
Thorough consultation with all professionals involved with the child is essential.
Suspicious or unclear condition
In this advice the phrase 'suspicious or unclear condition' refers to:
- any non-accidental or suspicious injury
- an undetermined illness
- unusual or obscure symptoms
- any injury, illness or symptoms where the cause is undetermined, suspicious or vague
- a condition where there is disagreement amongst assessing and treating medical staff.
Detailed assessment required
Where a child with whom child protection is involved is admitted to hospital with a suspicious or unclear condition, a detailed child protection assessment and thorough consultation with all professionals involved with the child is required. This applies for all children subject to child protection involvement, from children about whom a report has just been received through to children subject to long-term orders in out-of-home care.
Role to protect the child
The role of child protection is to protect the child by ensuring that a thorough medical and psychosocial investigation is conducted to ascertain the cause of the injury, condition or illness and to support the child's recovery.
Liaise with the hospital social worker
Admission of a current client to hospital requires the involvement of hospital social work staff.
The child protection practitioner should always liaise with the hospital social work department when a current client is admitted to hospital with a condition that is suspicious or unclear.
The social work department is an effective central contact point for information exchange between child protection and hospital medical staff throughout the child's hospital admission. Some major hospitals have an established paediatric social work department such as the Gatehouse Centre at Royal Children's Hospital, and Monash Medical Centre. See protocol Royal Children’s Hospital.
As in other circumstances child protection is required to ensure that the police are informed of physical or sexual abuse or serious neglect of a child, and to provide police with any new information in relation to the diagnosis. See Police protocol.
Prior to discharge
Medical assessment in writing prior to discharge
Where a client is admitted to hospital with a condition that is suspicious or unclear it is important that the child protection practitioner obtains written medical advice about the diagnosis (preferably prior to discharge), and in the event that differing medical opinion exists as to the diagnosis or cause of the child's condition, requests a forensic medical examination and written report.
Wherever possible, it is important to obtain clarification of the medical assessment before convening a case conference and prior to discharge from hospital to facilitate discharge planning and enable child protection to make an appropriate assessment of the child's needs. See procedure Medical and forensic examinations for tasks that must be undertaken and advice Victorian Forensic Paediatric Medical Service.
Case conference prior to discharge
Where a child protection client has been admitted to a hospital with an unconfirmed or suspicious or unclear condition, the child protection practitioner must consult their supervisor immediately.
A case conference with hospital medical staff and social work, other professionals, and the police should be held to inform assessment and as a mechanism to assist child protection understand the medical issues, probable causation, treatment needs and prognosis. Either child protection or the hospital social work department should coordinate the case conference arrangements.
Information gathered at the case conference is critical to risk assessment and decision-making about issues such as initiating legal action in the Children’s Court and planning around parental and other contact with the child while in the hospital.
Wherever possible, a senior practitioner, team manager or practice leader should attend the case conference along with the child protection practitioner.
Either child protection or the hospital may convene and chair the case conference.
Purpose of case conference
The purpose of the case conference is to:
- share information about the diagnosis or explanation of the child's condition
- develop a discharge plan
- establish actions required to ensure the child's safety.
The case conference will contribute to preparing the case plan for the child if protective concerns have been substantiated.
Review and endorsement
Where the team manager has not attended the case conference, they will review and endorse the discharge plan within the overall context of the case including the child's known medical history and child protection history. The team manager will make a record of their review and rationale for endorsing the discharge plan on CRIS.
Considerations for good practice
Confidentiality, privacy and information management
Best interests case practice
In the context of discharge planning for a child or young person with whom child protection are involved, the best interests of the child or young person, including their right to protection from harm and their development being promoted is the paramount consideration, underpinning all decisions and actions. Child protection practitioners have a particular role in assisting all parties to hold this in mind.