Principles governing practice

1. In line with Victoria's Children, Youth and Families Act (2005), the 'best interests of the child' are paramount and guide all decision-making.

2. The VFPMS is integrated with other paediatric health services. The VFPMS believes that each child should receive the right service, from the right professional, at the right time. Patient's medical needs and need for protection should determine the nature and timing of the service response.

3. Investigations of suspected physical, sexual and emotional abuse and neglect should involve a multi-professional team comprising of Health professionals, Child Protection professionals and Police. All members of the team should respect professional roles ad responsibilities and maintain high standards of practice, especially in relation to inter-agency communication.

4. Within the Health sector, situations of suspected physical, sexual and emotional abuse and neglect of a child a multidisciplinary response is considered 'best practice'.

5. When there are no concerns for a child's safety, thus no legislative requirement for actions such as reporting to Child Protection or police, client choice will determine the involvement or non-involvement of aspects of the service system's response.

6. Planning (and intervention) for each child's future physical, developmental and psychological wellbeing is a core function of the VFPMS.

7. All members of the VFPMS should participate in professional development, peer review, research, education and training, advocacy and quality improvement.

Credentialling

Credentialing of forensic paediatricians

Credentialling by the VFPMS is not yet operational in Victoria.

VFPMS awards a Certificate of Competency to trainees who have demonstrated proficiency when evaluating children in relation to suspected child abuse. This is not a "credential". 

The following information is for discussion only.

Credentials are for the purpose of identifying doctors who have demonstrated competencies in the evaluation of suspected child abuse. These doctors have also demonstrated that they can competently provide high quality expert opinion evidence (as distinct from direct evidence - ie evidence about what they saw, heard etc) in relation to child abuse.

Credentials are based on three factors:

- Qualifications
- Experience
- Demonstrated skill (which impacts good reputation) and appropriate behaviours

Qualifications in both paediatric medicine and forensic medicine

- FRACP or equivalent
- Grad Cert PaedForensMed, Grad Dip For Med, Master of Forensic Medicine or equivalent

Doctors must be actively involved in clinical practice

- Case work: Minimum of 5 children evaluated for child abuse per year - medical reports provided as proof of proficiency
- Continuing professional education
- Self-directed learning 30 hours per annum

Demonstrated skill

- Satisfactory presentation of evidence at case conferences or court
- Written reports subjected to peer review
- Chair case conferences (including SCAN meetings)

(What is NOT suggested is a minimum number of years of clinical work post graduation)

Scope of practice

VFPMS team members must adhere to workplace policies and procedures at all times. 
All data collection and data entry must be completed promptly and accurately.

Responsiveness

• Reply promptly to all telephone messages within 24 hours at the latest.
• All inpatient assessments (except in an exceptional circumstance) should be performed within 24 hours.

On call

• Doctors must be available to respond promptly (within 10 minutes) to telephone enquiries at all times that they are on call.
• Doctors should (except in an exceptional circumstance) be able to attend a hospital to see a child within two hours of initial contact.
• For inpatients, document the interim forensic opinion/recommendations and promptly discuss the VFPMS consultation with the General Medical Consultant.
• For children seen in Emergency Department, discuss the evaluation and management of children with the ED Consultant or Registrar.

Consent

• Examination must not proceed in the absence of valid consent and (where relevant) assent.
• Consent must be documented.
• Ideally, this should be in writing and detail the precise nature of the actions for which consent is provided. When consent is provided verbally or consent has been obtained by another professional, this too must be documented.
• The Gillick principle may apply for mature minors. The use of the VFPMS 'mature minors consent form' to document consent provided by mature minors is strongly recommended.

Documentation

• Contemporaneous notes must always be prepared for each face to face consultation and whenever advice is provided (face to face, telehealth, via telephone or email).
• Descriptions of physical examination findings should always be included. Diagrams are a useful adjunct to detailed descriptions. Photographs are an even more useful adjunct.
• Use of the proforma is strongly encouraged.
  
• Never alter, backdate, destroy, or otherwise interfere with patient related documents.
• Maintain the integrity of patient records at all times. Don’t write anything inappropriate, critical or discriminatory. Work notes can be subpoenaed and examined in court.

Examinations

• Consider the appropriate use of a chaperone or support person (and act in accordance with local hospital guidelines and protocols).
• Always wear gloves for examination of genitalia (male and female).
• All measures should be taken to minimise discomfort and prevent pain (e.g. moisten cotton tipped swabs, use warm water to lubricate speculum).

Reports

• A report must be prepared for each child seen.
• ALL reports must be read by a supervisor BEFORE release from the VFPMS.
• Reports should be completed in the shortest possible time.

Leave

• All requests for leave should be made with adequate notice.
• Time in lieu may be approved under limited circumstances with agreement from the Director. 
• Leave must be approved prior to taking leave. (Otherwise, absence is considered abandonment of one's job - this could have very significant consequences on one's employment!)

QA and peer review

• A minimum of four peer review sessions must be attended each year.
• All abnormal video/DVD colposcopy findings and all abnormal clinical examination findings must be reviewed by at least one senior specialist (preferably subjected to peer review).
• All staff must participate in annual staff appraisal.

Court

• Always respond appropriately to subpoenas. This might include telephoning the person who subpoenaed you.
• Always inform a VFPMS Nurse Manager of a subpoena, particularly when a subpoena may result in an anticipated absence from VFPMS clinic. 
• Attend court as required. Be prepared. Seek advice.
• Always inform the courts of any proposed absences from work, e.g. annual leave.