G101(P) A qualitative audit of child maltreatment assessment: hearing the child’s voice

Introduction This is a Child Maltreatment Audit to assess the quality of Child Sexual Abuse and Child Protection Medical Assessments. Child Maltreatment is a major public health issue globally. While there is evidence for the value of medical examination in child maltreatment cases, little is known of the quality of clinical assessment. We wanted to look at the quality of our clinical assessments in both Child Sexual Abuse (CSA) and Child Protection Medicals (CPM). Aims To determine whether we fulfil established minimum standards for the clinical assessment of child maltreatment and whether they are performed in a child friendly manor, do we hear the ‘voice of the child’? Methodology We analysed 50 records (randomly selected) against established good practice guidelines from the RCPCH, NICE and NSPCC. Results There were a total of 253 assessments during the time frame, 85% child protection medicals, and child sexual abuse medicals 15%. Children were aged between 9 months and 17 years of age. Discussion It is striking that 76% of children seen for CPM came from families where parents were separated and 40% came from households with domestic violence. 32% had 4 or more adverse childhood events (ACE’s).Of those children seen for CSA a higher proporti on came from households where domestic abuse, alcohol abuse/drug abuse, mental ill health or learning difficulties (56%) were present indicating potentially that carers were less able to provide protection. Stressful and poor quality childhoods are more likely to lead to health-harming and antisocial behaviours. Did we hear the ‘childs Voice’? In the majority of reports surveyed history was documented as obtained from the child (where the child was verbal). This was not always obtained in quotation marks. Some reports documented ‘selected quotes’. Some reports co ntained descriptive terms only. It was not clear whether children were spoken to alone i.e.without the parent/in some cases the perpetrator present unless this is documented at the start of the history. Conclusions Were our assessments child friendly and did we hear the voice of the child? More must be done to ensure the child’s voice and their wishes are recorded. Repeated media cases suggest we are not alone in failing to capture this. We have added an ‘aide memoir‘ to record the childs voice to place them at the centre of our assessments.