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Child protection in radiographic practice
THE RAD
LLEGE
OF
RAPHERS
Radiography
(1999) 5, 127-l 29
GUEST EDITORIAL
Child protection
in radiographic
Radiographers are accountable for their practice. In that practice they should always promote and safeguard the well being of people in their care. A traditional view of care might be specific to the examination itself, for example tending to the physical and emotional well being of patients in direct association with the diagnostic/therapeutic procedure. The contemporary view of care is more holistic, this often takes into account social circumstances. Abuse clearly falls into this category. This approach is consistent with seamless patient care and transparent inter-professional and inter-agency working. People who rely on others for their care are more at risk of abuse. Children, the elderly and the physically and mentally challenged are particularly vulnerable. A growing body of literature supports the view that all health and social care professionals have a responsibility for the protection of children. This is upheld even though the primary professional role may not formally involve the investigative and treatment processes for abused children and their carers. The child protection responsibilities of radiographers are clearly defined too. These responsibilities fall into two distinct categories: diagnostic imaging for clinical and evidential purposes-these have been well-documented [I] and the protection of children [2, 31. Protection of children, as part of the routine care given by radiographers, is an area of growing concern and interest [4-B]. However, radiographers’ knowledge of child protection has previously been reported as inadequate. In 1995 a regional survey of radiographers found that only 17% knew their Trust had procedures for child protection [9]; only one radiology department (in a District General Hospital) had a child protection policy [B]; radiographers often felt poorly prepared to deal with child protection matters [5]. To meet the demands of child protection radiographers must possess specific and generic skills. Specific skills will include the ability to manage effectively imaging procedures [I, 101. Whilst generic skills are wide ranging and include the ability to recognise abuse and how to deal with 1078-8174/99/030127+03
$18.00/O
practice I. Discuss immediately with a senior member of staff 2. Make a detailed record 3. Contact a member of the child protection team Figure
1.
1. Contact immediately a member of staff who has responsibility for child protection and discuss with a senior member of staff 2. Make a detailed record Figure
2.
situations where the radiographer suspects abuse, dealing with these situations is complex, requiring skills, a plethora of personal and interpersonal knowledge of policy and procedures and the ability to cope with emotionally taxing situations [B]. When abuse is suspected local procedures should indicate what steps must be taken. Figure 1 suggests a possible course of action where a radiographer feels a child in their care is being abused [II]. Figure 2 illustrates what action might be taken if a radiographer feels a child is in immediate danger [II]. Once the radiographer passes the information to a professional responsible for child protection the radiographer steps back and lets the professional manage the case. The radiographer may be called upon to provide evidence at a future date; consequently they should make a detailed record of events leading up to them seeking help from the professional with responsibility for child protection. It is not the responsibility of radiographers to inform parents or carers of suspected abuse, nor is it their responsibility to investigate it. Procedures for radiographers must be in place and these must be consistent with Trust and regional procedures and they must be followed precisely. Radiographers should therefore be aware of the general procedures from the region and the local procedures agreed by the Trust. Consistent 0 1999 The College of Radiographers
128
Hogg et al.
with these procedures, detailed guidelines should be available to inform radiographic practice and these should be adopted for working practice and should be updated as required. Clearly radiographers should be educated and trained to meet the demands of these responsibilities [7]. Child protection should therefore feature in pre-registration curricula, job induction programmes and regular updating should be included in continuing professional development (CPD) programmes. The training emphasis should be placed on generic skills related to child protection and specific skills about the imaging process itself.
Acknowledgements Between 1993 and 1997 the authors had the privilege of jointly leading a multi-professional research team that investigated the area of child protection in radiography. The composition
of the team was diverse
and included
represen-
tation from health and social services, police and clergy. The University of Salford and the Independent Order of Foresters financially students
supported
the
work.
from several universities
on aspects
of the subject
understanding
Over
IS
undergraduate
concentrated
to help
their projects
in the exploration
of the issues. Since 1993 members
and
of the team
have presented/published over 40 items in the field. Additionally some team members have assisted radiology departments to formulate their own child protection guidelines. Thanks are expressed to all those who have contributed to the work,
Examples of child protection radiographic practice
in
Radiographers are in a unique situation since they often have access to physical, social and radiographic information. Simply observing and listening to children and the way they interact with their carers can give clues about emotional abuse and neglect and children sometimes disclose to radiographers information about their abuse [s]. Classic examples of physical abuse may also be noted during radiographic procedures. For example during the imaging and/or therapy procedure, whilst children are undressed, inappropriate bruising may be noted; injuries presented may be inconsistent with explanations and certain medical image appearances are classic of physical abuse [u]. Managing procedures of known and suspected abuse can be emotionally taxing for radiographers. Personal feelings and previous experience of abuse may interfere with professional attitudes 181;consequently radiographers need to come to terms with their own emotional response to abuse. Education and training will play a part and counselling for radiographers should be made available whilst clinical supervision sessions will facilitate debriefing and sharing of experiences [B].
Summary Radiographers have clearly defined responsibilities in child protection; some are profession specific, others are generic to all health care workers. To become effective in these responsibilities radiographers must address individual learning needs and adopt working practices that are consistent with local and national child protection policy.
your efforts have been worthwhile
and have made an impact
on practice.
Peter Hogg” Dianne Hog@ Carena Eaton+ John SudberyS
“Head of Direcforafe, Directorate of Radiography, University uf Salford, Salfovd tHeahA Visifor, Barrowford Surgery, Barrowford, Lancashire +LecturerlClinicui Co-ordinator, Directorate of Radiography, University of Salford, Salford. §Lecttirev Direcforate of Social Wurk Studies, University of Salford, Salford, U.K.
Further Reading An Introductory Guide for the NHS: The Children Act 1989, HMSO 1989
References Brown AM, Henwood SM. Good practice for radiographers in non-accidental injury. Rudiogzpky 1997; 3: 201-S. Hogg I’, Blackledge K, Eaton C, O’Dee M, Sudbery J. The interface between child protection and diagnostic imaging. College of Radiographers Conference, Harrogate, 1994. Sudbery J, Hogg P, Hancock V, Eaton C. Child abuse and child protection-an overview for radiographers. Radiogr Tuduy 1994; 60: 13-15. Eaton C, Hogg P, Sudbery J, Hancock V. Child Protection: for Radiographers, Roentgen Centenary Implications Conference, Birmingham, I 995.
Guest Editorial 5. Hogg I’, Sudbery J, Eaton C. Child protection in radiography: exemplars from clinical practice. Radiology UK, Invited Review, Birmingham, 19%‘. 6. Hogg I’, Sudbery J, Eaton C. Child protection in radiographic practice: is it more than imaging? Radiology, UK, Invited Review, Birmingham, 1999. 7. Eaton C, Hogg I’, Sudbery J. Child protection: education and training implications for radiographers, Radiology UK. Invited Review, Birmingham, 1997. 8. Sudbery J, Eaton C, Hogg I’. Child protection and abuse: an overview, Radiology UK. 1997 Invited Review, Birmingham, 1997.
129
9. Sudbery J, Eaton C, Hancock V, Hogg I’. Child protection and radiography: social and emotional context. Child Abuse Review 1997; 6: 283-90. 10. Hancock V, Sudbery J, Eaton C, Hogg P. Child protection and radiography: clinical and technical factors. Child Abuse Review 1997; 6: 191-8. 11. Child Protection Procedures, Lancashire Child Protection Committee (Burnley Health Care NHS Trust), Services allied to medicine child protection procedure. 12. Hogg I’, Blackledge K, Eaton C, Sudbery J, Odee M, Wright G. Diagnostic imaging of physical child abuse. Radiography 1994; 60: 13-6.
LLEGE
OF
RAPHERS
Radiography
(1999) 5, 127-l 29
GUEST EDITORIAL
Child protection
in radiographic
Radiographers are accountable for their practice. In that practice they should always promote and safeguard the well being of people in their care. A traditional view of care might be specific to the examination itself, for example tending to the physical and emotional well being of patients in direct association with the diagnostic/therapeutic procedure. The contemporary view of care is more holistic, this often takes into account social circumstances. Abuse clearly falls into this category. This approach is consistent with seamless patient care and transparent inter-professional and inter-agency working. People who rely on others for their care are more at risk of abuse. Children, the elderly and the physically and mentally challenged are particularly vulnerable. A growing body of literature supports the view that all health and social care professionals have a responsibility for the protection of children. This is upheld even though the primary professional role may not formally involve the investigative and treatment processes for abused children and their carers. The child protection responsibilities of radiographers are clearly defined too. These responsibilities fall into two distinct categories: diagnostic imaging for clinical and evidential purposes-these have been well-documented [I] and the protection of children [2, 31. Protection of children, as part of the routine care given by radiographers, is an area of growing concern and interest [4-B]. However, radiographers’ knowledge of child protection has previously been reported as inadequate. In 1995 a regional survey of radiographers found that only 17% knew their Trust had procedures for child protection [9]; only one radiology department (in a District General Hospital) had a child protection policy [B]; radiographers often felt poorly prepared to deal with child protection matters [5]. To meet the demands of child protection radiographers must possess specific and generic skills. Specific skills will include the ability to manage effectively imaging procedures [I, 101. Whilst generic skills are wide ranging and include the ability to recognise abuse and how to deal with 1078-8174/99/030127+03
$18.00/O
practice I. Discuss immediately with a senior member of staff 2. Make a detailed record 3. Contact a member of the child protection team Figure
1.
1. Contact immediately a member of staff who has responsibility for child protection and discuss with a senior member of staff 2. Make a detailed record Figure
2.
situations where the radiographer suspects abuse, dealing with these situations is complex, requiring skills, a plethora of personal and interpersonal knowledge of policy and procedures and the ability to cope with emotionally taxing situations [B]. When abuse is suspected local procedures should indicate what steps must be taken. Figure 1 suggests a possible course of action where a radiographer feels a child in their care is being abused [II]. Figure 2 illustrates what action might be taken if a radiographer feels a child is in immediate danger [II]. Once the radiographer passes the information to a professional responsible for child protection the radiographer steps back and lets the professional manage the case. The radiographer may be called upon to provide evidence at a future date; consequently they should make a detailed record of events leading up to them seeking help from the professional with responsibility for child protection. It is not the responsibility of radiographers to inform parents or carers of suspected abuse, nor is it their responsibility to investigate it. Procedures for radiographers must be in place and these must be consistent with Trust and regional procedures and they must be followed precisely. Radiographers should therefore be aware of the general procedures from the region and the local procedures agreed by the Trust. Consistent 0 1999 The College of Radiographers
128
Hogg et al.
with these procedures, detailed guidelines should be available to inform radiographic practice and these should be adopted for working practice and should be updated as required. Clearly radiographers should be educated and trained to meet the demands of these responsibilities [7]. Child protection should therefore feature in pre-registration curricula, job induction programmes and regular updating should be included in continuing professional development (CPD) programmes. The training emphasis should be placed on generic skills related to child protection and specific skills about the imaging process itself.
Acknowledgements Between 1993 and 1997 the authors had the privilege of jointly leading a multi-professional research team that investigated the area of child protection in radiography. The composition
of the team was diverse
and included
represen-
tation from health and social services, police and clergy. The University of Salford and the Independent Order of Foresters financially students
supported
the
work.
from several universities
on aspects
of the subject
understanding
Over
IS
undergraduate
concentrated
to help
their projects
in the exploration
of the issues. Since 1993 members
and
of the team
have presented/published over 40 items in the field. Additionally some team members have assisted radiology departments to formulate their own child protection guidelines. Thanks are expressed to all those who have contributed to the work,
Examples of child protection radiographic practice
in
Radiographers are in a unique situation since they often have access to physical, social and radiographic information. Simply observing and listening to children and the way they interact with their carers can give clues about emotional abuse and neglect and children sometimes disclose to radiographers information about their abuse [s]. Classic examples of physical abuse may also be noted during radiographic procedures. For example during the imaging and/or therapy procedure, whilst children are undressed, inappropriate bruising may be noted; injuries presented may be inconsistent with explanations and certain medical image appearances are classic of physical abuse [u]. Managing procedures of known and suspected abuse can be emotionally taxing for radiographers. Personal feelings and previous experience of abuse may interfere with professional attitudes 181;consequently radiographers need to come to terms with their own emotional response to abuse. Education and training will play a part and counselling for radiographers should be made available whilst clinical supervision sessions will facilitate debriefing and sharing of experiences [B].
Summary Radiographers have clearly defined responsibilities in child protection; some are profession specific, others are generic to all health care workers. To become effective in these responsibilities radiographers must address individual learning needs and adopt working practices that are consistent with local and national child protection policy.
your efforts have been worthwhile
and have made an impact
on practice.
Peter Hogg” Dianne Hog@ Carena Eaton+ John SudberyS
“Head of Direcforafe, Directorate of Radiography, University uf Salford, Salfovd tHeahA Visifor, Barrowford Surgery, Barrowford, Lancashire +LecturerlClinicui Co-ordinator, Directorate of Radiography, University of Salford, Salford. §Lecttirev Direcforate of Social Wurk Studies, University of Salford, Salford, U.K.
Further Reading An Introductory Guide for the NHS: The Children Act 1989, HMSO 1989
References Brown AM, Henwood SM. Good practice for radiographers in non-accidental injury. Rudiogzpky 1997; 3: 201-S. Hogg I’, Blackledge K, Eaton C, O’Dee M, Sudbery J. The interface between child protection and diagnostic imaging. College of Radiographers Conference, Harrogate, 1994. Sudbery J, Hogg P, Hancock V, Eaton C. Child abuse and child protection-an overview for radiographers. Radiogr Tuduy 1994; 60: 13-15. Eaton C, Hogg P, Sudbery J, Hancock V. Child Protection: for Radiographers, Roentgen Centenary Implications Conference, Birmingham, I 995.
Guest Editorial 5. Hogg I’, Sudbery J, Eaton C. Child protection in radiography: exemplars from clinical practice. Radiology UK, Invited Review, Birmingham, 19%‘. 6. Hogg I’, Sudbery J, Eaton C. Child protection in radiographic practice: is it more than imaging? Radiology, UK, Invited Review, Birmingham, 1999. 7. Eaton C, Hogg I’, Sudbery J. Child protection: education and training implications for radiographers, Radiology UK. Invited Review, Birmingham, 1997. 8. Sudbery J, Eaton C, Hogg I’. Child protection and abuse: an overview, Radiology UK. 1997 Invited Review, Birmingham, 1997.
129
9. Sudbery J, Eaton C, Hancock V, Hogg I’. Child protection and radiography: social and emotional context. Child Abuse Review 1997; 6: 283-90. 10. Hancock V, Sudbery J, Eaton C, Hogg P. Child protection and radiography: clinical and technical factors. Child Abuse Review 1997; 6: 191-8. 11. Child Protection Procedures, Lancashire Child Protection Committee (Burnley Health Care NHS Trust), Services allied to medicine child protection procedure. 12. Hogg I’, Blackledge K, Eaton C, Sudbery J, Odee M, Wright G. Diagnostic imaging of physical child abuse. Radiography 1994; 60: 13-6.