Refer to VFPMS

This section contains information for professionals from Child Protection, Victoria Police and Health. It aims to provide a better understanding of how the Victorian Forensic Paediatric Medical Service works, how decisions are made and how to contact the service.

In Melbourne, regular outpatient clinics are available at the Royal Children's Hospital and Monash Children's Hospital. 

In other regional cities children are seen on an 'ad hoc' basis as the need arises. 

Children who require a non-urgent assessment may be offered an appointment during working hours where this is available. In regional cities a non-urgent assessment may be provided in an outpatient clinic, an emergency department or, in limited circumstances, in a paediatrician's private rooms. 

Children who require an urgent evaluation may be offered an after hours service by the multidisciplinary team.

Criteria for referral

1. Forensic evaluation of injury or suspected injury
2. Allegation of sexual assault
3. Symptoms and signs that generate concern regarding possible child abuse, assault or neglect
4. Risk of harm based on psychosocial circumstances and co-existing concerns for a child's health, safety, growth, development, behaviour or relationships
   

Prioritisation for urgent face-to-face assessments will be given to children under the following circumstances:

• Medical symptoms such as pain and bleeding require urgent assessment and possible treatment of injury
• Collection of samples for forensic analysis (e.g. rape kit); note the recommended maximum times for collection of forensic samples 
• Medical treatment is required but cannot be provided elsewhere (e.g. provision of post-coital contraception and antibiotics to prevent STI including HIV). Note that under most circumstances such medical care can be provided by medical services other than VFPMS.
• A forensic opinion is required regarding the cause and timing of injury (or differentiating a medical condition confused with injury from true injury) in order to make decisions regarding health, protective and legal interventions for the index child and/or siblings
• Urgent paediatric assessment of safety (particularly involving an assessment of health and adequacy of healthcare) is required in order to make decisions regarding the index child's and/or siblings' safe placement
• The current social situation places a child at temporary risk that might be mitigated or resolved as a result of a medical consultaiton. For example, a significant level of care-giver's emotional distress and/or anger might pose a risk to the child's (or another individual's) safety and/or emotional wellbeing.

Criteria for determining urgency

Telephone advice is available 24/7 by telephoning 1300 66 11 42.

Urgent consultations at RCH and MCH will be provided under the following circumstances:

• A face-to-face consultation will usually be provided for the collection of forensic samples following recent sexual assault
• A face-to-face consultation will be provided for an inpatient at RCH and MCH about whom there are concerns regarding non-accidental injury

Non-urgent face-to-face consultations will usually be offered to all other children for whom a VFPMS face-to-face consultation is deemed necessary. Most children will be seen within 1-2 weeks of the referral. 

Neglect

The VFPMS welcomes the opportunity to provide forensic medical opinions in relation to children who might have experienced serious negative effects of child neglect. We are particularly keen to provide comprehensive assessments of young children and children with complex health needs who may have suffered because of care-giver neglect of their medical needs. 

A small number of sibling groups may be assessed per annum. When several children in one family may have been affected by child neglect then younger children and children with complex health needs will be prioritised. The VFPMS may not accept all children in one family for individual forensic medical assessments. 

In situations of child neglect the amount and quality of information provided by Child Protection to the VFPMS is of paramount importance. The VFPMS expects to work in partnership with Child Protection practitioners regarding the evaluation of suspected child neglect.

Sexual abuse

Children may be referred to the VFPMS because of allegations of sexual assault, concerns regarding child sexual abuse and for evaluation of symptoms and signs (including sexualised behaviour) that generate concern regarding possible sexual abuse. 

The VFPMS provides assessments for the purposes of:

• Healthcare (including injury evaluation and treatment, prophylaxis of STI and prevention of pregnancy)
• Criminal investigations (including genital examination and collection of samples for forensic DNA analysis) and production of medicolegal reports that might be used in the criminal justice system
• Protective assessments (including production of medicolegal reports that might be used in the Children's Court of Victoria)

The VFPMS will provide a service to children when sexual assault/abuse is suspected but police are NOT investigating possible criminal behaviour and Child Protection are NOT investigating possible child abuse or neglect. In other words, the involvement of Victoria Police and/or Child Protection is not a requirement for referral to the VFPMS.

Referral process for regional Victoria

For information regarding all rural and regional referrals, please go the Rural and regional page.

Remember – advice and consultation is available 24/7 on tel: 1300 66 11 42

VFPMS out-of-hours on-site consultations at RCH & MCH from 1st July 2024

VFPMS doctors make decisions about whether to attend RCH or MCH after hours to provide VFPMS assessments of physically or sexually abused children based on the child’s best interests and need for medical care, forensic sample collection and safety. The VFPMS doctors arrange out-of-hours consultations on a case-by-case basis mindful of the child’s circumstances and need for a forensic medical evaluation, competing priorities, availability resources, and stakeholder needs.

Under exceptional circumstances, VFPMS doctors will provide out-of-hours examinations over night when a ‘next day’ service is not able to be scheduled or the case-details are unusual and extenuating. 

Attendance for examination of IN-PATIENTS at RCH and MCH

In-patients referred to VFPMS after 5pm on any day of the week, including weekends, will typically be seen the following day.  Under exceptional circumstances, seriously physically injured children admitted to PICU or NICU might be seen over-night.

Attendance during evenings and over-night for examination of victims of sexual assault

Recommended timeframes for forensic specimen collection from child and adolescent victims of sexual assault guide decision-making about timing of VFPMS consultations.

VFPMS doctors will provide an out-of-hours response to recently sexually assaulted children when forensic specimen collection is required (within recommended timeframe) AND

1. Referrals are received prior to 9pm.
2. Referrals received after 9pm but before midnight AND sexual assault occurred within the previous 12 hours. When allegations are limited to recent oral penetration (no other body site penetrated) AND children have not eaten or drunk then recommendations will likely be made for Police to collect mouth swills and wipe perioral regions using dampened gauze from Early Evidence Kits (EEK).
3. Under exceptional circumstances, for example in relation to a strong suspicion of a recent Drug Facilitated Sexual Assault.  

When referrals are received after midnight, recently sexually assaulted children will be offered an appointment in VFPMS Clinic the following day (this includes weekend days and public holidays). Under exceptional circumstances an examination and forensic sample collection might be provided over-night following discussion with senior staff from VFPMS and the referring agency.

Prioritisation of ‘next day’ sexual assault consultations

Sexual assault assessments that were deferred to the following day will be prioritised over in-patient consultations and existing scheduled outpatient appointments.