Referral Process
Process following a referral to the Victorian Forensic Paediatric Medical
Service
Summary of the service delivery pathway
Referrals may be received from:
- Child Protection
- Victoria Police
- Internal Departments, ED, paediatrics, mental health, counselling,
social work
- Other health services, MCHN, or GP’s
- Parents, relatives
- Child or young person
- Other professionals
Triage and Intake
The initial response to a phone call to the
service is to assess the level of urgency for the child or young
person to determine the most appropriate immediate response;
trained clinical staff, in consultation with others such as,
Child Protection, Victoria Police and/or other clinical staff,
will make this decision.
Access to triage is available 24 hours
a day, 7 days per week. Out of business hours, this may be provided
in collaboration with staff located within emergency departments,
centres against sexual assault or counselling.
Assessment
When preliminary screening suggests that a child or young person
may have been abused, the VFPMS will carry out a comprehensive
forensic medical assessment. If the abuse is sexual then CASA
counselling staff will be included at the time of the assessment.
In other cases counselling or other mental health services may
be included as part of referrals for other health needs.
This is usually done at a VFPMS site, but outreach assessment
is available for a child or young person under particular circumstances
such as serious illness. Because outreach assessment involves
significant additional time and costs it is used only where a
child or adolescent is considered to be at significant risk and
when it would not otherwise be possible to do the assessment.
At assessment, the child/adolescent is generally registered
as a public health service client. This involves explaining the
privacy implications and the safeguards that protect patient
privacy, together with collection of basic demographic information
on a registration form to establish a confidential record in
the health service and on the VFPMS database.
Assessment may include a physical examination and talking to
the child or young person as well as parents or carer to:
- identify symptoms and signs of sexual, physical or emotional
abuse or neglect;
- assess the child’s developmental status and its relevance
to the presenting problems;
- determine appropriate referral pathway
- collect evidence for court.
A full forensic paediatric assessment, diagnosis and initial
treatment planning generally takes about 1.5 hours.
Some children may require further specialist assessment of
their psychological and neuropsychological status; cognitive,
speech and language function; developmental stage; educational
attainment; and/or capacity in social relationships.
Family assessment may also be needed to understand the interaction
between a child’s difficulties and those of their parents,
and provide appropriate support and advice.
After assessment:
- the child/young person and their family/carer may be given
information and advice, and/or may be referred to other departments
or organisation.
The Specialist Paediatric Forensic Medical Service Delivery Pathway
see larger
view of the flowchart (PDF 39KB)
Principles underpinning the Integrated Response
- In line with Victoria’s Child Youth and Family Act,
the ‘best interests of the child’ are paramount
and guide all decision-making.
- Policy direction is informed by scientific principles related
to levels of evidence. The VFPMS policies and practices are
reviewed regularly to ensure monitoring of quality, and updating
as necessary.
- All investigations of suspected physical, sexual and emotional
abuse and neglect of a child or young person involve a coordinated,
multi-professional team comprising Health professionals, Child
Protection professionals and Police. All members of the team
respect professional roles and responsibilities and maintain
high standards of practice, especially in relation to inter-agency
communication.
- Within the Health sector, in all situations of suspected
physical, sexual and emotional abuse and neglect of a child
or young person a multidisciplinary response is considered ‘best
practice’. The VFPMS and counselling services (such as
Gatehouse Centre and SECASA) provide concurrent and coordinated
responses at all times. A VFPMS and counselling professional
are available for every client seen.
- When there are No concerns for a child/young person’s
safety, client choice will determine the involvement or non-involvement
of aspects of the service response. (Clients and their guardians
have the right to decline the involvement of either or both
medical and/or counselling professionals)
- Client need determines the nature and timing of the service
response. For example, when the probability of child abuse
is low, and the diagnosis of child abuse can be Excluded promptly
by VFPMS evaluation, the child/young person’s need for
a prompt diagnosis may occur without a concurrent counselling
response. (For example, evaluation of suspected Mongolian Blue
spots). When a child and their care-givers request counselling
in relation to past child abuse, and the child is currently
asymptomatic, a counselling response may be provided without
a concurrent VFPMS response.
- The VFPMS is integrated with all other paediatric health
services. The VFPMS ensures that each child receives the right
service, from the right professional, at the right time (regardless
of location within the health sector).
- Planning (and intervention) for each child’s future
physical, developmental and psychological wellbeing is a core
function of the VFPMS.
- All members of the VFPMS participate in professional development,
peer review, research, education and training, advocacy and
participate in quality assurance activities.
Definitions
Urgent medical need
- Genital
bleeding
- Genital
pain
- Other significant physical symptoms that might be related
to abuse (this requires sufficient knowledge and skills to
make an evaluation of a child’s health and/or injuries)
Alternative medical service
This will be determined by the child’s specific medical
needs (knowledge of the broad range of health services within
the community and within the Acute Health sector is required
in order to determine the most appropriate service.
Child and Family Services
Support services that assist families to identify and reduce
personal and social stresses that can lead to family breakdown
and/or child abuse. They include in-home family support, counselling,
parenting support.
