Child Protection - we all have a role to play

Queensland Ambulance Service staff will play an additional and important legal role protecting some of the state’s most vulnerable, as the organisation works towards becoming a Child Safe organisation.

Medical Director Dr Steve Rashford said these changes were made in response to changes to the Queensland Criminal Code last year. (You can read the Medical Circular 39/2021 here.)

“These changes mean all QAS staff, both corporate and operational, now have a legal duty to protect the vulnerable from sexual abuse, particularly children under the age of 16 and people with a mental impairment under the age of 18 years,” Dr Rashford said.

The Criminal Code changes were made as part of a national response to the findings of the Royal Commission into Institutional Responses to Child Sexual Abuse, which uncovered shocking abuse of children within Australian institutions.

The Australian Human Rights Commission was tasked with developing guidelines for this national response, National Principles for Child Safe Organisations.

“The QAS recognises all children and young people attending Queensland Health services have the right to feel safe, valued, listened to, and informed,” Dr Rashford said.

“The QAS has formed a working group to review, develop and implement a Child Protection Framework to ensure we meet our legislative responsibilities, address the National Principles and ensure Queensland Health’s commitment is upheld.”

Working group Secretariat Elizabeth Santillan said this group included representatives from Clinical, Corporate, Cultural Safety, Health Contact Centre (HCC), and Human Resources and Operations.

“We want to this framework ensure our staff feel educated and supported to report any concerns they may have about the safety of a child or vulnerable person under 18, as it is now a mandatory obligation,” Ms Santillan said.

“We will be working closely with Queensland Health and other relevant agencies to develop a reporting process and a mandatory training package for our workforce.”

Dr Rashford said the QAS was proud to work towards becoming a Child Safe organisation.

For QAS to be a Child Safe organisation, this means we consciously and systematically:

• create an environment where a child’s safety and wellbeing are at the centre of our thought, values and actions

• place emphasis on genuine engagement with, and valuing of children and vulnerable young people

• create conditions that reduce the likelihood of harm to children and vulnerable young people

• create conditions that increase the likelihood of identifying any harm and respond to any concerns, disclosures, allegations, or suspicions.

“While our workforce has a longstanding high level of trust in our community, this strengthens our reputation as a safe place for children and vulnerable people in our care,” he said.

Information about QAS’s Child Protection Framework is available on the Portal and the page will be updated as more resources become available to staff.

Putting the framework into action

By Luke Hinds, Senior Clinical Educator West Moreton District

Clinical situation:

When responding to a 11-year-old reported to have self-harmed you are met on scene by a parent who states they had stopped the child from “cutting” themselves and that there had been a lot of arguments and stress within the household recently. The parent introduces you to the patient who seems withdrawn and despondent. The parent seems disinterested in the patient apart from when you are asking the patient questions.

Questions:

1. What can be done to encourage the patient to discuss their presentation?2. The parent is obviously required to attend hospital with the patient as their guardian but during the interaction with the patient you note they are reactive to the parent and sometimes demonstrate fear or withdrawal if the parent goes to touch them?

3. What can be done to assist with creating an environment where the patient can discuss their concerns?

4. During a moment with the patient while the parent is called away the patient asks to not be left alone with the parent as they have been touching them. The parent quickly returns, and the patient withdraws again. How can you manage this?

5. At hospital you provide handover about the situation while the parent and patient are present. What more can be done?

Supporting information:

Overt disclosure of sexual abuse in children is a reportable event but more subtle cases where suspicion is present that abuse may be occurring require more investigation.

In this circumstance clinicians should try to create a safe environment that allows the patient to discuss and express their presentation and rationale for behaviour.

Clinicians should practise active and supportive listening (careful not to judge). In the setting of having a parent on scene this can be a barrier to communication and a suggestion to discuss the patient’s presentation away from the parent could provide important information either by letting the patient express their concerns without the influence of an adult or allowing the clinician to observe the behaviour of the adult when this is suggested.

Obvious disclosure of sexual abuse is a reportable under the framework, but without disclosure clinicians should express their concerns and observed behaviours to the emergency department – this can be done discretely away from the patient.

The behaviours displayed and reporting of concerns regarding not feeling safe by the patient are red flags and need to be followed up. Changes in behaviours, self-harm, social withdrawal and conflict can all be behavioural cues of abuse.

If overt disclosure of abuse of a sexual nature is made, then clinicians are required to report this using the processes via either by calling the Child Safety Services Regional Intake Service or completing the ‘Report of suspected child in need of protection’ Form. Information regarding reporting has previously been released and can be found in the CPG and the QAS Portal.

It is also very important to document your findings on the eARF as these may be requested via QAS Patient Records, to be provided to the Child Safety team. Documentation is a powerful source of information assisting decision making within the Child Safety environment.

Finally, the move to mandatory reporting will assist with protecting children and provides a clear direction on the responsibility of clinicians and a commitment to the values of child protection are important steps for us as individuals and as an organisation.

It is important to know this role extends beyond the hours of work and across clinical and non-clinical roles.

Reporting can result in significant change for a child at risk or having experienced harm.

QAS recognises the importance of these steps and will support its employees to report with a commitment to protect the individual when reporting abuse. This includes protecting the identity of the individual making a report and disclosing only the information required under the Act to protect an at-risk child.

To keep up to date, make sure you review all correspondence on this topic and check the Child Protection page on the QAS Portal for future updates.