Abstract

Child abuse cases are such that no authority can handle them alone. It takes a team approach involving cooperation between all responsible authorities. According to the Swedish Law of Secrecy medical and social authorities have the right to give information to each other in cases of abuse up to the age of 18. The Law of Social Service says that anyone working with chil-dren, i.e. in school, day care center, health service etc. is obliged immediately to report to the social welfare office any knowledge of a child who might need protection as well as upon suspicion of abuse of any kind.

The Norrköping region has 37,000 children under the age 18 years. There are 70-80 reports of child abuse each year. Since 1984 we have established in Norrköping a routine for child abuse case conferences. Any professional can request a case conference but it is usually done by the social welfare officer. The conference is held as soon as possible preferably on the same day or the day after a report is received.

Those who take part in the conference are the social welfare authority, public prosecutor, police, pediatrician, child psychiatrist and occasionally also a gynecologist.

The first conference must:

  • Evaluate the situation of the child and the content and validity of the report.
  • Plan who shall do what, when and in which order.

The social welfare authority documents the conference.
If necessary there are continuous conferences. Who shall take part is decided from case to case. In every case there are two social officers, one of them senior. The physical examination is done by two senior specialists (pediatricians, pediatrician + gynecologist or medico-legal officer) and the police investigation by one out of three officers with special training. When the investigation is finished a follow up conference is held to evaluate the result of the investigation and the need for further support for child and family.

Twice a year a permanent group of representatives from the different authorities meets to discuss and systematize experiences with a view to further developing of case handling routines and planing information and training programs.

Our experience is that it takes a team approach and adherence to a strict routine from the beginning of each case to achieve the best possible investigation result as well as the best legal, social and psychological outcome for the child.

A permanent group with representatives of authorities is a valuable resource for advice in difficult cases and for discussing and implementing rules and routines in the local area. Personal knowledge facilitates contact for discussion.

Case Conferences and Cooperation in Child Abuse
Ladies and gentlemen,
I am going to present a model for case conferences and cooperation to handle child abuse cases. It is a model we have found to be well functioning for many years.

I will not present the results of a scientific study but only an account of the organization and our practical experience. Perhaps you will find some of it worth bringing home to see if it can fit into your own local circumstances.

In the mid 1970-ties we saw at the Dept. of Pediatrics some cases of severe child abuse. We became very frustrated about how these cases were handled by the social authorities and the social authorities on their hand were not always satisfied with how we in the hospital handled the same cases. We therefore met to discuss how to make things better.

Some years later the County Administrative Board took an initiative to developing routines for child abuse cases. All authorities involved soon realized that child abuse cases are such that no authority can handle them alone. They require a team approach and cooperation between all responsi-ble authorities.

After 4-5 years we had established routines which are still in practice.

According to Swedish Law of Secrecy medical and social authorities have the right to give information to each other in cases of abuse when the child is younger than 18 years of age.

The Law of Social Service says that anyone working with children, i.e. at school, day care center, public or private health service etc. is obliged to report without any delay to the Social Welfare Office any knowledge of a child who might need protection. Such a report is mandatory already when there is suspicion of physical, sexual or emotional maltreatment as well as other bad social circumstances. This is valid even if there is no solid proof at the moment. Some of those who have a suspicion want to be more sure before they make a report and therefore will try to make their own further investigations. We discourage such private investigations, as they tend to de-lay the report to the social authorities and adequate actions to be taken. It also carries the risk to impair the chances to secure legal evidence.

The Norrköping region has 37,000 children under the age 18. There are 70-80 reports of suspected child abuse each year. Since 1980 we have established a routine for child abuse case conferences. Any professional can request a case conference but it is usually done by the social welfare officer. The conference is held as soon as possible preferably on the same day or the day after a report is received.

Those who take part in the conference are: two social welfare officers, a public prosecutor, a police officer, a pediatrician, a child psychiatrist or psychologist and occasionally a gynecologist.

The first conference must:

  • Evaluate the situation of the child and the content and validity of the report.
  • The social authority must decide on how to secure the child’s safety
  • The public prosecutor has to decide on if there are evidence enough to initiate preliminary hearings. He also has to decide on whether a suspected perpetrator shall be taken into custody or not.
  • There must also be discussed and agreed upon who shall do what, when and in which order. This is important for two reasons. To make the investigation as mild as possible for the child and family. That the investigations of the different authorities do not interfere with each other.
  • Regardless if any police investigation is made or not, the social authorities will always make their own investigation and see to the child’s overall social circumstances.
  • The Social Welfare Authority documents the conference. If necessary there are continuous conferences. Who shall take part in these is decided from case to case.

There are always two social officers appointed for the social part of the investigation, at least one of them is senior. The physical examination of the child is usually done by two senior specialists (it can be two pediatricians, a pediatrician and a gynecologist or a pediatrician and a medico-legal officer). The police investigation is performed by one out of three police officers who all have special training and the investigation is led by an experienced public prosecutor.

When the investigation is finished a follow up conference is held to evaluate the result of the investigation and the need for further support for child and family.

Twice a year a permanent group of representatives from the different authorities meets to discuss and systemize experiences. The aim is to further develop case handling routines and to plan information and training programs.

Conclusion
Our experience is that it takes a team approach and adherence to a strict routine. Especially at the beginning of each individual case, to achieve the best possible investigation result as well as the best legal, social and psychological outcome for the child and to avoid cases slipping through cracks in the system.

A permanent group of experienced people is a valuable resource for advice in difficult cases and for discussing and implementing rules and routines in the local area.

Those who take part in the permanent group shall do so for a period of several years because it takes long time to learn how to handle these delicate problems. It also takes time to build up confidence and knowledge of people, which makes mutual contacts easier.