Child protection for psychiatrists — structured clinical viva

This is child sexual abuse with ongoing risk, sibling risk, and dual loyalty because mother is also a patient. The adolescent's preference not to involve police does not erase professional duties when significant harm is disclosed and siblings may be unprotected.^[1][2]

Immediate tasks. Ensure current safety (no unsupervised contact with alleged perpetrator). Believe and validate without leading multi-interview contamination. Document contemporaneous quotes. Arrange specialist paediatric/forensic sexual abuse evaluation pathway as indicated. Assess suicide/self-harm risk and acute trauma symptoms.^[2][4]

Reporting. On reasonable suspicion/disclosure of abuse, report via designated local child-protection channels. Explain to the young person, honestly, the limits of confidentiality and why siblings must be considered. Do not invent statute numbers; name local multi-agency pathway principles.^[1]

Mother and parental capacity. Mild intellectual disability does not equal global incapacity to parent or to protect. Assess multi-dimensional parenting capacity and ability to protect both children from the stepfather; assess her capacity for her own decisions separately (understand, appreciate, reason, communicate).^[3] Support mother without colluding with minimisation or retaliation risk.

Multi-agency. Children's social care/CPS, police (as indicated by duty and safety), health, education. Safety plan for sister is non-negotiable.^[1][2]

Psychiatry. Trauma-informed care; TF-CBT adaptations for complex trauma when indicated; treat depression/anxiety/self-harm; long-term outcomes literature supports early protection plus treatment rather than silence.^[4][5]