Friday, 27 October 2000

For immediate release

Dr Kim Bannister Honorary Secretary

“Stop the Hurt” conference gets preview of GP abuse resource

A resource aimed at helping GPs recognise and manage child abuse is almost ready for release, the Royal NZ College of General Practitioners has told the “Stop the Hurt” conference at Parliament.

The College’s Honorary Secretary Dr Kim Bannister told delegates that his organisation has been working with CYFS developing the resource, and offered a preview of its contents. The document, still in draft form, emphasises that safety of the child is the paramount consideration, reinforces that early referral to an appropriate authority is necessary for definite or probable child abuse, and that there are no legal barriers to such a referral.

The key points of the referral process are: 1. The need to keep an open mind about the possibility of child abuse. 2. Always seek advice – the issue requires multi-disciplinary expertise. 3. Take an accurate account of the problem and record it. 4. Look for signs of abuse and document adequately. 5. Refer to an appropriate agency. 6. Ensure that feedback is provided about the child’s progress. 7. Maintain a relationship with the child and family where possible.

Referral strategies are categorised according to whether child abuse is definite or probable, or uncertain.

For definite or probable child abuse the following responses are recommended 1. If domestic violence or concerns about immediate safety are present –contact police 2. If injuries require medical treatment - contact paediatrician 3. If sexual abuse is suspected - contact Doctors for Sexual Abuse Care 4. For all other situations - contact CYFS Where child abuse is uncertain advice is to telephone and discuss history and findings with one of the following alternatives - Doctors for Sexual Abuse Care - CYFS - Paediatrician - Youth Health Services - An experienced colleague

Where a child is thought to be at risk of abuse or neglect, referral is recommended to other support services as appropriate and available, such as Family Start, Public Health Nurses, Barnados, Plunket, Child Abuse Prevention Society, Parentline, Women’s refuge, iwi social services, or Pacific Peoples’ Social Service.

The guideline also covers the legal provisions, the processes used by CYFS to manage referrals, whether to inform families, cultural considerations, other support services, and the signs of child abuse and neglect.

Dr Bannister stressed, however, that the effectiveness of a resource such as this “depends on the availability of funding to promote and explain its use, usually in small groups. Without such support, guidelines are unlikely to be widely understood, accepted or used by the group they are designed for,” he told the conference.

He also took the opportunity to reiterate that the College does not support the mandatory reporting of all cases of suspected child abuse. The main concerns are: - Too broad a definition of child abuse might require minor instances (such as smacking) to be reported to the authorities when they may be better dealt with by other agencies. - Because of this, the child abuse agency (CYFS) is at risk of being swamped with reports which are mostly for minor problems where the child is not as risk of serious injury. There is evidence this happens overseas. - International evidence is that mandatory reporting provisions increase the percentage of reports which turn out to unsubstantiated after they have been investigated. - The stress to a family of being reported for suspected child abuse is immense, and is a significant toll from a mandatory reporting regime where most reports are ultimately unsubstantiated. There is also a negative effect on the family’s relationship with their GP at a time when they may benefit most from the value of a trusting relationship of this nature.

“Not all children are equally at risk,” Dr Bannister told the conference. “Child abuse and neglect is highly associated with poverty and with multi-problem families (who have difficulties such as parental alcoholism and drug abuse; psychiatric illness and social isolation). It is therefore important for GPs to be particularly on the alert for such high-risk ‘red flag’ families”.

ends

Contact: Dr Kim Bannister (09) 479-5027 or (021) 618-527 Dr Ralph Wiles, Chairperson (07) 886-5239 or (021) 658-564 or: Rex Widerstrom (04) 496-5962 or (025) 549-637

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