6147 An audit of child protection medical assessments within a community paediatric department

Objectives The audit's objective was to evaluate the quality and effectiveness of the child protection medical assessments performed within our Community Paediatric department according to standards set out by local guidelines and RCPCH Child Protection Service Delivery Standards.1 An additional objective was to obtain information about local trends in child abuse and its presentation, recognition and response. Methods Cases were identified from the departmental child protection database. Assessments performed within a 6-month period between September 2022 to February 2023 were identified and electronic patient record (EPR) notes reviewed for 41 index cases. Siblings of index cases were excluded. Results All cases had a written report. 85% were referred for suspected physical and 12% suspected sexual abuse. 78% were reviewed within 24 hours of referral. The proforma was used in 98% and 90% of reports were sent to social care within the 10-working day target. 44% had a peer review discussion documented on the child's EPR. In 35% of reports, neurodiversity was mentioned and 17% had an education, health and care plan (EHCP) compared to 4% of pupils in England.2 The fewest reviews took place in December and only 1 on a Monday with 8–12 on each other day. A social worker attended 90% of assessments and 71% had previous social care involvement. 48% had documentation of a strategy meeting. Following assessment, 37% were subjected to a child protection plan and 5% placed in care. Conclusion A robust system is in place for child protection medical assessment. A higher proportion of children had an EHCP compared to the general population, supporting evidence that children with disabilities may be more vulnerable to abuse.3 It should be considered if a specific referral pathway is required for those identified to have possible neurodiversity at the time of child protection assessment as this was documented in over a third of assessments. A peer review discussion template will be created and someone allocated to complete this in the child's EPR. Further audit to review sibling child protection medicals is planned. Due to the change in Paediatric training structure with fewer registrars allocated to Community Paediatrics locally, the information gathered may help with child protection rota planning. Details regarding social care involvement will provide helpful feedback and support requests for ongoing social worker presence at assessments, at a time when there can be challenges in this area. This promotes information sharing and closer multidisciplinary team working. References 'Good practice service delivery standards for the management of children referred for child protection medical assessments', RCPCH Child Protection Special Interest Group, October 2020. 'Special educational needs in England', Gov.uk, 22/6/2023. 'Abuse in special circumstances', Child Protection companion, RCPCH, 2022.