Psych MEQs / SAQs · Child and adolescent psychiatry — child protection for psychiatrists
Child protection thresholds and multi-agency response (MEQ)
FRANZCP-style MEQ on child protection thresholds, documentation, multi-agency working, dual loyalty, parental capacity, and trauma-informed care.
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(i) Definition and subtypes. Child maltreatment is acts of commission or omission by caregivers (or others in positions of trust/power) causing actual or potential harm to health, development, or dignity. Here: possible physical abuse, emotional abuse, neglect (hunger, inadequate protection), and exposure to violence by mother's partner. Long-term mental and physical health consequences of physical abuse, emotional abuse, and neglect are well established.[1][3]
(ii) Immediate assessment. Prioritise safety today for the 9-year-old and the 2-year-old. See the child alone (age-appropriate, non-leading). Document quotes, injuries, who was present, and developmental observations factually. Map multi-agency information (school, GP, prior services). Sibling risk is mandatory. Medical/paediatric review of bruises as indicated. Do not discharge to unresolved danger.[2]
(iii) Thresholds and confidentiality. Report on reasonable suspicion of significant harm via designated local child-protection channels — not courtroom proof. Confidentiality has lawful limits when a child is at serious risk; share minimum necessary information and record the basis. Duties and forms are jurisdiction-specific — state principles; do not invent section numbers.[2]
(iv) Multi-agency and dual loyalty. Coordinate CAMHS/health, children's social care/CPS, education, and police if crime/imminent harm. Mother's request for secrecy does not override the child's paramount welfare when thresholds are met. Continue compassionate treatment of mother's depression and alcohol use while refusing collusion.[2][6]
(v) Parental capacity and treatment. Assess multi-dimensional parenting capacity (basic care, safety, warmth, stimulation, guidance/boundaries, stability) and how depression/alcohol/partner violence impair it — distinct from capacity for her own medical consent (understand/appreciate/reason/communicate).[4] Offer trauma-informed care for the child (including TF-CBT adaptations where indicated), treat parental illness/substance use as risk-modifying, and match statutory intensity to child risk.[5][6]
References6ShowHide
- [1]Gilbert R, Widom CS, Browne K, et al. Burden and consequences of child maltreatment in high-income countries Lancet, 2009.PMID 19056114
- [2]Gilbert R, Kemp A, Thoburn J, et al. Recognising and responding to child maltreatment Lancet, 2009.PMID 19056119
- [3]Norman RE, Byambaa M, De R, et al. The long-term health consequences of child physical abuse, emotional abuse, and neglect: a systematic review and meta-analysis PLoS Med, 2012.PMID 23209385
- [4]Appelbaum PS Clinical practice. Assessment of patients' competence to consent to treatment N Engl J Med, 2007.PMID 17978292
- [5]Cohen JA, Mannarino AP, Kliethermes M, Murray LA Trauma-focused CBT for youth with complex trauma Child Abuse Negl, 2012.PMID 22749612
- [6]MacMillan HL, Wathen CN, Barlow J, et al. Interventions to prevent child maltreatment and associated impairment Lancet, 2009.PMID 19056113