Curriculum standards
Entrustable Professional Activities
LG9: Clinical assessment and management – child safety and maltreatment
Clinical assessment and management – child safety and maltreatment
Clinically assess and manage cases of suspected child maltreatment across multiple settings
This activity requires the ability to:
- thoroughly and appropriately identify, assess, and document children presenting with signs or symptoms of child maltreatment
- appropriately manage patients where there are concerns for child maltreatment, in conjunction with relevant agencies
- perform and document detailed forensic examinations for the detection of injury
- formulate defensible decisions regarding possible child maltreatment
- communicate and collaborate with relevant child statutory child protection agencies and police
- produce appropriately peer reviewed medicolegal reports for the child protection and criminal justice system
- demonstrate knowledge of regulatory and legal requirements related to child maltreatment information and reporting
Professional practice framework domain
Medical expertise
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- recognise signs of child maltreatment, such as physical or sexual abuse, neglect, emotional maltreatment, exposure to violence and drug endangerment
- identify, assess, and document children presenting with signs or symptoms of child maltreatment
- perform detailed examinations for the detection of injury in infants, children, and adolescents
- manage patients where there are concerns for child maltreatment, in conjunction with other relevant agencies
- conduct chaperoned external genitalia examination in consenting children and adolescents, where indicated, in the appropriate clinical setting (in line with RACP Guidance on genital examinations)
- arrange appropriate evidence-based investigations in cases of suspected child maltreatment
- demonstrate an awareness of the process for accurate collection of forensic samples for children with acute sexual assault concerns, in liaison with child maltreatment specialist paediatricians, child protection agencies, and police
- consult specialists, such as child maltreatment specialist paediatricians, radiologists, neurosurgeons, and ophthalmologists, in cases of child maltreatment
- formulate defensible evidence-based opinions in relation to likelihood of child maltreatment, in consultation with child maltreatment specialist paediatricians
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- recognise injury types, and describe simple injury mechanisms
- demonstrate the ability to formulate differential diagnosis for presentation of child maltreatment
- demonstrate appropriate escalation for support and supervision to perform examinations in suspected child maltreatment
Communication
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- clearly document assessment findings in patients’ medical records, including necessary forensic documentation
- prepare timely and accurate communication in the form of letters and reports to disseminate relevant medical information to patients, other health professionals, and other relevant agencies
- communicate effectively with other professionals involved in patients’ lives to promote wellbeing, such as those working in education, mental health, allied health, statutory child protection services, and police
- produce comprehensive medicolegal reports, that are appropriately peer reviewed, for the child protection and criminal justice system
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- document objective findings of injuries in children
- appropriately report cases of suspected child maltreatment to statutory child protection agencies
Quality and safety
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- identify and respond to all injuries in pre-mobile infants
- recognise clinical presentations in which child maltreatment should be a considered differential diagnosis in the absence of obvious injury
- identify limits of expertise, and determine the need for child maltreatment specialist involvement
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- recognise various clinical presentations that may occur because of child maltreatment
- follow local jurisdictional procedures for the notification of suspicions of child maltreatment
Cultural safety
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- advocate for cultural safety in clinical settings
- demonstrate effective and culturally safe communication and care for Māori and Aboriginal and Torres Strait Islander peoples
- link patients with culturally appropriate support services
- collaborate with families and communities to optimise patient health outcomes in a culturally safe manner
- use qualified language interpreters or cultural interpreters where appropriate
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- demonstrate cultural safety
Ethics and professional behaviour
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- demonstrate an awareness of complex issues related to the documentation of sensitive information gathered in clinical encounters, and subsequent sharing of such information
- demonstrate an understanding of the medicolegal requirements of written communications
- obtain informed consent from patients and families to conduct general physical examinations, such as photographic recording of injuries and anogenital examinations
- follow regulatory and legal requirements and limitations regarding reporting child maltreatment
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- follow regulatory and legal requirements and limitations regarding reporting child maltreatment
Judgement and decision making
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- make appropriate decisions regarding reporting suspected child maltreatment to statutory child protection agencies
- formulate defensible medicolegal opinions based on current literature and evidence
- develop management plans considering the balance of benefit and harm by taking patients’ personal sets of circumstances into account
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- recognise personal limitations and, when required, seek help an appropriate way
- consider the best interest of the child in decision making
Leadership, management, and teamwork
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- engage and facilitate multidisciplinary team meetings, family meetings, and complex case conferences
- work collaboratively with police and statutory child protection agencies
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- participate in multidisciplinary child maltreatment meetings
Health policy, systems, and advocacy
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- advocate for appropriate resources to assist families and protect children
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- demonstrate understanding of the social determinants of health at a population level