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 3, 30 June 2022.
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 potential or confirmed non-accidental or suspicious injury
- 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 risk assessment required
Where a child with whom child protection is involved is admitted to hospital with a suspicious or unclear condition, the child protection practitioner must consult with their supervisor immediately.
A detailed child protection risk 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 and in care.
Update essential information categories and complete a risk assessment to inform decision making.
Role to protect the child
The role of child protection is to assess and ensure the child is safe and that their needs are being met, 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
The involvement of hospital social work staff is required when a current client of Child Protection is admitted to hospital with suspicious injuries or illness. The child protection practitioner should always liaise with the hospital social work department in these cases. The social work department can be 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 pediatric social work department such as the Gatehouse Centre at Royal Children's Hospital, and Monash Medical Centre. See protocol Royal Children’s Hospital.
Review and update essential information categories following contact with the hospital social worker and medical staff.
As in other circumstances child protection is required to ensure that the police are informed of reports of, or confirmed 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 medical advice about the diagnosis (preferably in writing and prior to discharge). In the event that a comprehensive forensic medical assessment is required for a court proceeding, or if a differing medical opinion exists as to the diagnosis or cause of the child's condition, the child protection practitioner should make a referral to the Victorian Forensic Pediatric Medical Service.
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 risk and of the child's needs. See procedure Medical and forensic examinations for tasks that must be undertaken and advice Victorian Forensic Paediatric Medical Service.
Where a child has been admitted to hospital with suspicious of unclear condition, a case conference, or Suspected Child Abuse and Neglect (SCAN) meeting, should be held as soon as possible with hospital medical and social work staff, other professionals, and, where required, the police, 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 obtained 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. This reduces delays in decision making, in the event that information or outcomes arise from the case conference that require an immediate response (including the initiation of legal intervention)
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:
- seek, share, and understand 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 important information for your essential information categories, to be considered within your analysis, judgements, and formulation of your case plan, if one is required.
Review and endorsement
Where the team manager has not attended the case conference, they will review and provide necessary feedback or recommendations on 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 supporting the discharge plan on CRIS.
Where a risk assessment or review risk assessment has been completed, a team manager or above must complete the endorsement on CRIS.
Considerations for good practice
Confidentiality, privacy and information management
A focus on the child's best interests
In the context of discharge planning for a child or young person with whom Child Protection is 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.