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​​What happens next?

Many people worry that by making a referral to children's services, they will initiate a process that will quickly get out of hand, and end up with severe and drastic action being taken to remove the child and punish the family. This is a misperception that does not reflect current practice in the UK where:

    • less than 50% of children investigated for possible abuse end up being placed on child protection registers​13​

    • it is estimated that fewer than 1% of children referred to children's services for possible abuse end up in judicial proceeding​​s27

What happens when children's services receive a referral?

When a child is referred to children's services, the duty social worker may ask whether you are aware if, or inform you that, the child has been subject to a CAF. The social worker will note details of the child and family and the concerns that are being raised. What procedures are followed after that?

Some cases will not be escalated to a child protection enquiry. Sometimes other services can be identified as appropriate to resolve the issues of concern for the child and family.

If a case is already open to children’s services with a lower level input, your referral may increase the level of concern and escalate activity to a child protection enquiry or Section 47 enquiry.

What further action might you be asked to take?

If you have made a child protection referral, you may be asked to provide a report for a case conference or be requested to give evidence in court.

When else might your help be requested?

You may be asked to help in the child protection process by assessing the dental needs of children who have been abused, whether existing patients of your practice or new.

What procedures are followed after that?

When a referral has been received, the social work team manager will convene a strategy discussion (often by telephone) with a senior member of the police child protection team. This happens within one working day and often involves a paediatrician or other health professional. The purpose of this strategy discussion is to share information and decide on how best to manage the referral, taking note of the concerns that have been raised. They may decide that a social worker will visit the family to carry out an initial assessment or initiate a joint investigation with the police. If the concerns are minor, or the family is already known to other professionals, it may be appropriate for those professionals to take the lead in supporting and working with the family, rather than continuing down a child protection route. In extreme cases, where there is the risk of immediate harm to the child, legal action may be required through an emergency protection order or police powers of protection.

In those cases where the initial assessment identifies ongoing concerns and risks, a multiagency case conference may be held. Parents are normally invited to these conferences. At the conference, all those present are given an opportunity to share information about the child and family, including any concerns they may have. The conference chair then summarises any identified risks to the child, along with any factors that may be serving to protect the child or support the family. The professionals decide whether the child remains at continuing risk of harm and therefore should become the subject of a child protection plan (formerly children would be placed on the local child protection register). An action plan is then agreed with the family in order to provide support and ensure the safety of the child. The child protection conference meets again after three months to review the circumstances and adherence to the child protection plan (the plan is not usually discontinued at this stage unless the child has been removed into local authority care). Subsequent conferences are held at six month intervals until such time as the child is no longer felt to be at risk of significant harm. At any stage in this process, it may be necessary to take legal action to protect the child, but this would only be where it has been shown that the child cannot be protected without recourse to such action.Further details of the process are discussed in current statutory guidance.1

Coping with the aftermath

It is quite normal to have some anxiety about the consequences of making a child protection referral. These may include fears about potential adverse consequences for the child or family, or repercussions on your dental practice or yourself.5,29 Talking it through, or ‘debriefing’, with an experienced colleague may be helpful or you may wish to seek independent confidential counselling. This may be available through your local occupational health department or child protection named nurse (see Finding your local contacts).

‘I still think this is a really difficult thing for us, working in a small town where everyone knows everyone else’

A dental practice owner

'I had some sleepless nights after I referred the little girl. I wondered whether I had done the right thing. It helped to talk to someone who had seen this kind of thing before.'

A dental practice owner

‘Child protection is a difficult area of practice that can involve making decisions that are emotionally challenging, complicated by uncertainty and sometimes go against the wishes of parents.’

General Medical Council, 2012​ 40​​

Giving evidence in court

In cases of severe child abuse or neglect, two parallel legal processes may be required: the prosecution of an alleged offender in the criminal courts and the protection of children under the Children Act in the civil courts. The two processes take different routes and rely on different levels of evidence. The decision as to whether or not criminal proceedings should be initiated is undertaken by the police in conjunction with the Crown Prosecution Service and based on three main factors:

    • whether or not there is sufficient evidence to prosecute;

    • whether it is in the public interest that proceedings should be instigated against a particular offender;

    • whether or not a criminal prosecution is in the best interests of the child.

The evidential standard required by the criminal court is proof ‘beyond reasonable doubt’ that the defendant committed the offence. In contrast, civil proceedings are initiated by the local authority for the protection of the child and rely on finding ‘on the balance of probabilities’ that a child has suffered or is likely to suffer significant harm.

As a professional involved in a case, you may be called upon to provide evidence in either court. In both situations your responsibility to the court is to provide an accurate and unbiased account of your findings, your opinion based on those findings and any action that you took as a consequence. In a court situation, you should never venture beyond your level of expertise or provide opinions that you are unable to back up.

Further advice is available from your defence organisation. Support and training may be available locally for those unfamiliar with court procedures. Your local child protection named nurse or doctor may be able to advise (see Finding your local contacts).

Assessing the dental needs of children who have been abused

Children who have been subject to abuse or neglect need a full assessment of their health and developmental needs. This process is coordinated by children's services and may require input from a range of professionals. You may be called upon to assess the dental health, oral injuries and unmet dental needs of such children, whether existing patients of your practice or new. In such circumstances the social worker should have obtained consent for dental examination from the parent, alternatively the courts may order an assessment to be carried out. If consent is not available, seek the advice of an experienced colleague or defence organisation before proceeding.

Particular attention should be paid to the following:

    • oral examination and assessment of dental h​ealth and oral hygiene;

    • documentation of any injuries and interpretation in the light of any history given and the developmental stage of the child;

    • records of previous dental attendance and treatment (which may provide a positive indicator of appropriate care);

    • treatment required, in your opinion, and how it could be carried out.

All assessments should be thoroughly documented, dated and signed. You may be required to provide a written report for children's services, or in criminal or civil proceedings a statement that may be placed before the courts.

Further advice is available from your defence organisation.