Auckland District Health Board
PATIENTS/CLIENTS/RESIDENTS
(Section 5)
Board Policy Manual
CHILD PROTECTION ALERTS MANAGEMENT
Overview
This Document
ADHB has had a “Child Protection Alert” system since 2002. Since
January 2009, ADHB Child Protection Alerts have been uploaded
into the National Medical Warning System, linked to the NHI
(National Health Index) number.
If other factors for concern about child protection exist, the
absence of a Child Protection Alert should not be regarded as
evidence that a child or young person is not at risk.
The system informs ADHB staff that health records relevant to child
protection, are held by the ADHB. It also enables health
professionals in some other DHB to become aware of this fact also.
However, at present most DHBs do not routinely place or access
Alerts through the NMWS. If you know that a child at risk is moving
into an area covered by another DHB, it is still best to communicate
that information directly to appropriate staff in that DHB.
Note that there are several different clinical information systems
within the ADHB. These include Concerto and CRIS (inpatient
services), HCC (community services) and Healthware (lead
maternity carers). AT PRESENT, CHILD PROTECTION
ALERTS PLACED FOLLOWING THIS POLICY ONLY
APPEAR ON CONCERTO AND CRIS. If you have concerns
which need to be communicated to community services or lead
maternity carers, you will need to approach those services directly.
This policy outlines some basic principles behind the Child
Protection Alert system, and describes the steps to be followed when
ADHB staff want to place a Child Protection Alert [CPA] on the
clinical records of a child or young person, or remove such an Alert.
Quality and consistency of Child Protection Alerts is of fundamental
importance. These Alerts are audited regularly.
Section:
File:
Classification:
Patients, Clients, Residents
81928249 Authorised by:
PP01/PCR/038.DOC
Child Protection Alerts Management
Issued by: Clinical Director Te Puaruruhau
Chief Executive Officer
Date Issued:
December 2009
Page:
1 of 10
Board Policy Manual
PATIENTS/CLIENTS/RESIDENTS
(Section 5)
Auckland District Health Board
CHILD PROTECTION ALERTS, MANAGEMENT OF
Topic
See Page
Overview ..................................................................................... 1
Introduction ................................................................................. 3
Principles ..................................................................................... 4
Criteria for placing a Child Protection Alert ............................... 6
Process for placing a Child Protection Alert ............................... 7
Information to support a Child Protection Alert ......................... 8
Removing a Child Protection Alert ............................................. 9
What to do when you see a Child Protection Alert ................... 10
Section:
File:
Patients, Clients, Residents
81928249 Authorised by:
Issued by: Clinical Director Te Puaruruhau
Chief Executive Officer
December 2009
Page:
2 of 10
Child Protection Alerts, Management of
Auckland District Health Board
PATIENTS/CLIENTS/RESIDENTS
(Section 5)
Board Policy Manual
CHILD PROTECTION ALERTS MANAGEMENT
Introduction
Purpose
To ensure that safe and consistent practices are followed by ADHB
staff when placing Child Protection Alerts on clinical records
Scope
This policy applies to all staff, contractors and students within
Auckland District Health Board who wish to place Child Protection
Alerts on clinical records, Concerto, CRIS or the National Medical
Warning System
Associated
documents
The table below indicates documents associated with this policy.
Type
Board Policy
Manual
Legislation
Other
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Section:
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Classification:
Document Title(s)
Access to Patient Information
Bicultural – responsibilities under Te Tiriti O Waitangi –
Tikanga RBP
Child Abuse/Neglect, Care and Protection
Child Protection Alert Documentation
Informed Consent
Legal issues related to Children
Privacy of Patient Information
Health Act 1956 (and Amendments 1993)
Children Young Persons and Their Families Act 1989 (and
Amendments 1994)
Privacy Act 1993 (and Health Information Privacy Code 1994)
Aotearoa NZ Association of Social Work [ANZASW] Code of
Ethics and Core Competencies
Child Protection Alert System within Health, Policy Paper,
Paediatric Society of New Zealand, February 2009
Final Report on the Investigation into the death of James
Whakaruru, Office of the Commissioner for Children, June 2000
Starship Children’s Health – Clinical Guidelines for Abuse and
Neglect
Patients, Clients, Residents
81928249 Authorised by:
PP01/PCR/038.DOC
Child Protection Alerts Management
Issued by: Clinical Director Te Puaruruhau
Chief Executive Officer
Date Issued:
December 2009
Page:
3 of 10
Board Policy Manual
PATIENTS/CLIENTS/RESIDENTS
(Section 5)
Auckland District Health Board
CHILD PROTECTION ALERTS, MANAGEMENT OF
Principles
Background
Acts of child abuse are seldom single events. Many children
diagnosed with abuse have previous child protection concerns,
evidence of old injury, or have been seen with vague symptoms that
in retrospect could have been indicators of abuse. Most cases of
serious abuse occur in infants and pre-verbal children, who are
unable to tell others. Such abuse is under-diagnosed, in part because
signs and symptoms are missed due to a lack of diagnostic suspicion.
Many children who die from abuse are unknown to CYF, but most
are known to health. Many families are highly mobile. Reports
highlight how important it is for health services to share information
about children at risk, and how often this fails to happen.
Women may present in pregnancy in circumstances which will create
high risk for the baby after delivery. Failure to recognize and respond
to these women appropriately, may result in poor outcomes. A Child
Protection Alert lodged on the file of a pregnant woman is often
referred to as an “Antenatal Alert”. This is transferred onto the
child’s file after delivery, if risk persists.
Alerts draw the attention of clinical staff to serious child protection
concerns already known within the health system, so they can decide
its relevance to the latest presentation. This information must be
readily available. Police and CYF data is not readily accessible to
health providers, who will only contact them if already concerned.
The purpose of entering these Alerts onto the National Medical
Warning System is to make relevant health information available to
other DHBs as a child moves around New Zealand.
An Alert merely draws our attention to past history. If other
current factors for concern about child protection exist, the
absence of a Child Protection Alert should not be regarded as
evidence that a child or young person is not now at risk.
Section:
File:
Patients, Clients, Residents
81928249 Authorised by:
Issued by: Clinical Director Te Puaruruhau
Chief Executive Officer
December 2009
Page:
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Child Protection Alerts, Management of
Auckland District Health Board
PATIENTS/CLIENTS/RESIDENTS
(Section 5)
Board Policy Manual
CHILD PROTECTION ALERTS MANAGEMENT
Principles
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The following principles are fundamental to the system:

Consistent minimum criteria. CPA will only be placed if the level
of risk is such that the child has been referred to CYF.

Consistent process. CPA will only be placed if the decision to do
so has been formally reviewed by a multi-disciplinary team with
expertise in child protection.

Consistent health information. Any CPA placed must be
supported by enough health information to inform subsequent
clinical decision-making by other health professionals.
Patients, Clients, Residents
81928249 Authorised by:
PP01/PCR/038.DOC
Child Protection Alerts Management
Issued by: Clinical Director Te Puaruruhau
Chief Executive Officer
Date Issued:
December 2009
Page:
5 of 10
Board Policy Manual
PATIENTS/CLIENTS/RESIDENTS
(Section 5)
Auckland District Health Board
CHILD PROTECTION ALERTS, MANAGEMENT OF
Criteria for placing a Child Protection Alert
All children and young people referred to CYF, and all women
referred to CYF during pregnancy because of risk to the unborn
child, must be notified to Te Puaruruhau for consideration of a Child
Protection Alert.
Making the
decision
Most children and young people referred to CYF will merit a CPA,
but it is not necessarily the case that all will do so.
The key question is: is there a potential future risk to this child or
young person’s health, which placing a CPA may avert?
In some circumstances (for example, a stranger sexual assault where
there is no ongoing risk of abuse, and an unnecessary risk to the
victim’s privacy from placing a CPA), a CPA may not be indicated.
Each decision must be considered on a case-by-case basis, by a
multi-disciplinary team with experience in child protection.
Minimum Criteria
1
A child or young person must be 0 – 16 years (up to 17th
birthday). This includes unborn children.
2
The child or young person (or, in the case of an unborn child,
the mother) has been seen by ADHB services
AND
3
The child or young person (or, in the case of an unborn child,
the mother) has been notified to CYF by ADHB.
OR
4
The child or young person (or, in the case of an unborn child,
the mother) is already an open case with CYF, and there are
current child protection concerns
Section:
File:
Patients, Clients, Residents
81928249 Authorised by:
Issued by: Clinical Director Te Puaruruhau
Chief Executive Officer
December 2009
Page:
6 of 10
Child Protection Alerts, Management of
Auckland District Health Board
PATIENTS/CLIENTS/RESIDENTS
(Section 5)
Board Policy Manual
CHILD PROTECTION ALERTS MANAGEMENT
Process for placing a Child Protection Alert
Process
The following steps are taken when placing a Child Protection Alert.
Step
1
2
3
4
5
6
7
6
7
8
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Action
The health professional who notified CYF, or who has been
informed of CYF involvement, sends a copy of the CYF
referral to Te Puaruruhau (preferably by email to
[email protected]), along with any other relevant child
protection information.
Receipt of this information by Te Puaruruhau will
automatically generate a multi-disciplinary Alert discussion
Standard practice is for ADHB staff to inform the family that
a referral to CYF has been made, and the reasons for that
referral. The family are not further informed that a CPA
has been placed, unless they specifically ask about it.
Te Puaruruhau reviews the information at a multidisciplinary meeting, and decides whether it meets the
criteria for placing an Alert. The referring health professional
is welcome to participate in this review.
If insufficient information is available to decide if an Alert is
warranted, the request may be returned to the clinician.
Te Puaruruhau both completes and approves the “Clinical
Alert Notification / Cancellation” Form (CR0008).
Te Puaruruhau sends this to clinical records to be placed on
the child or young person’s clinical record – or, in the case of
a pregnant woman where high risk has been identified
(“Antenatal Alert”), on the woman’s clinical record. The
CR0008 will only be sent to Clinical Records accompanied
by some form of “Child Protection Report” (see next page)
Clinical Records sets up electronic CPA on Concerto / CRIS
Clinical Records enters CPA on children and young people
under the age of 17 years, onto the National Medical
Warning System (NMWS). The NMWS entry reads as
follows: “Child Protection Concerns: contact ADHB”
Te Puaruruhau reviews “Antenatal Alerts” after the baby has
been born, and decides whether the Alert should be
transferred to the newborn baby’s file. The referring health
professional is welcome to participate in this review.
Patients, Clients, Residents
81928249 Authorised by:
PP01/PCR/038.DOC
Child Protection Alerts Management
Issued by: Clinical Director Te Puaruruhau
Chief Executive Officer
Date Issued:
December 2009
Page:
7 of 10
Board Policy Manual
PATIENTS/CLIENTS/RESIDENTS
(Section 5)
Auckland District Health Board
CHILD PROTECTION ALERTS, MANAGEMENT OF
Information to support a Child Protection Alert
The “Clinical Alert Notification / Cancellation” Form (CR0008),
does not provide enough information to fulfil the purpose of a CPA.
Process
The following steps must be taken to provide adequate information to
make a Child Protection Alert useful to other clinicians.
Minimum information includes:
 The nature of the care and protection concerns
 If an “Antenatal Alert”, the Estimated Date of Delivery (EDD)
 The relationship and name of the alleged offender (if known) to
the child or young person
 The date of referral to CYF
 Where the Alert is placed for a child already under investigation
by CYF, what the active concerns are.
 The name of an ADHB clinician familiar with the child
protection concerns
The information should be in the form of one of the documents
detailed below
Step
1
2
2
3
4
Action
The health professional who notified CYF, or senior
clinician who has been informed of CYF involvement,
provides the backing information.
Acceptable backing information is one of the following:
 A CYF referral (CR2692)
 A Soprano MedDocs Child Protection Report (Te
Puaruruhau or Children in Care)
 Alternative Child Protection Report (CR8980).
These documents are forwarded to Clinical Records along
with the Child Protection Alert form (CR0008).
Clinical Records enters the documents informing the Child
Protection Alert, under the Child Protection Folder on CRIS
Other documents of relevance to Child Protection can be
included in the Child Protection Folder, in discussion with
Te Puaruruhau
Section:
File:
Patients, Clients, Residents
81928249 Authorised by:
Issued by: Clinical Director Te Puaruruhau
Chief Executive Officer
December 2009
Page:
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Child Protection Alerts, Management of
Auckland District Health Board
PATIENTS/CLIENTS/RESIDENTS
(Section 5)
Board Policy Manual
CHILD PROTECTION ALERTS MANAGEMENT
Removing a Child Protection Alert
Overview
All Child Protection Alerts are automatically removed from Concerto
and CRIS within a month of the child / young person’s 17th birthday.
Child Protection Alerts on the file of a woman in pregnancy because
of risk to the unborn (“Antenatal Alerts”), are removed after the baby
is born, and transferred to the baby’s file if there is ongoing risk.
CPA may also be removed at the specific request of the child or their
representative (including from the NMWS), if the multi-disciplinary
child protection team agrees that the risk has been eliminated.
This page outlines the steps followed in these procedures.
Removal of the CPA does not remove the child protection
information from the clinical record. Management or requested
amendment of health information in the clinical record is governed
by the health information policies and procedures of the ADHB.
Step
1
2
3
4
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Action
Clinical Records supplies Te Puaruruhau every month with a
list of CPA in persons 17 years or older
The Te Puaruruhau Team Support lodges an Alert
Cancellation form (CR0008) for all those 17 years and over,
who are not identified as an Antenatal Alert
Any request to remove or alter a CPA prior to the 17th
birthday, must be made to the Clinical Director of Te
Puaruruhau, for approval by the multi-disciplinary team and
completion (if approved) of a CR0008 (Cancellation) form.
The CR0008 (Cancellation) form is sent to Clinical Records,
who cancel the Alert on CRIS and Concerto.
Patients, Clients, Residents
81928249 Authorised by:
PP01/PCR/038.DOC
Child Protection Alerts Management
Issued by: Clinical Director Te Puaruruhau
Chief Executive Officer
Date Issued:
December 2009
Page:
9 of 10
Board Policy Manual
PATIENTS/CLIENTS/RESIDENTS
(Section 5)
Auckland District Health Board
CHILD PROTECTION ALERTS, MANAGEMENT OF
What to do when you see a Child Protection Alert
A CPA merely draws attention to health information recorded in the
past that may or may not be relevant to current health.
Overview
Past information should always be interpreted in the context of the
current presentation. The presence of a CPA does not necessarily
mean that the child or young person is still at risk. If you are
uncertain, always seek advice.
If, in the course of assessment, a current child protection concern is
identified, staff should follow ADHB Child Abuse Policy.
This page outlines the steps to be followed when an ADHB clinician
notices that a Child Protection Alert exists.
Step
1
2
3
4
5
6
7
Action
ADHB clinician notices a Child Protection Alert Flag
Look on Concerto for a MedDocs “Child Protection Report”
If that is not present, or contains insufficient information, go
to CRIS. There should be a “Child Protection Folder”. Enter
that folder, and read the relevant documents
If no Child Protection report can be found in Concerto or
CRIS, go to the Alert folder, and identify the clinician who
lodged the Alert. Contact that clinician
If no Child Protection Report can be found in Concerto or
CRIS, email Te Puaruruhau ([email protected])
Assess the relevance of the historical information in context
of the child’s presenting concerns and living situation.
Consult with a senior clinician prior to discharge
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Patients, Clients, Residents
81928249 Authorised by:
Issued by: Clinical Director Te Puaruruhau
Chief Executive Officer
December 2009
Page:
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Child Protection Alerts, Management of