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A child in need of protection


​Maris arrives a​t a client's home for a scheduled post-partum visit. Brooke, the client, takes several minutes to answer the door and appears tired and distracted. Maris sees Brooke's four week-old son, Nathan, lying on the sofa crying uncontrollably. Maris asks Brooke if it would be okay if she picked up the baby, and Brooke replies, “Yeah, sure. Maybe you can get him to stop crying."


When Maris picks up the baby it is evident he needs a diaper change. Maris offers to change the baby and tells Brooke this will allow her do Nathan's assessment at the same time. Brooke agrees and gives Maris the necessary supplies.  During the diaper change Maris notices purple, brown, and yellow bruises on Nathan's inner thighs and buttocks. When Maris asks Brooke about the bruises Brooke heatedly replies, “I don't know. It's no big deal."  Maris completes the assessment and finds nothing else of concern. Maris documents the findings, including a description of the bruises and concerns of possible physical harm to the baby.

During Brooke's postpartum assessment Maris asks again about Nathan's bruises but Brooke continues to be dismissive on the subject. Brooke ends the assessment before Maris finishes, citing another appointment, and asks Maris to leave. Maris offers to come back another time but Brooke declines.

Maris is concerned about both the baby and Brooke but is unsure about what to do. She suspects Nathan is being physically harmed but is not certain. Maris doesn't want to involve child welfare services if Nathan is not at risk.

Let's look the consequences of  two potential decisions that Maris could make:

Scenario 1: Maris does not report

Maris decides she is overreacting and does not report her suspicions to child welfare services. A few weeks later Maris hears from another midwife in the clinic that Nathan was hospitalized with injuries consistent with shaken baby syndrome. Maris tells the midwife about the bruises from the four-week postpartum visit. Maris receives an email from BCCNM that a complaint has been made about her and she is being investigated for her failure to report a child at risk of harm. A criminal investigation is also opened around this failure to report.

Scenario 2: Maris reports

After the postpartum visit, Maris immediately calls child welfare services and reports the suspicions to a child protection social worker. The report is investigated by child protection services who work out a plan with the family that uses available community services to support the family's ability to keep Nathan safe.


Your respo​​nsibility

Any person, including a midwife, who believes that a child (defined as a person under 19 years of age) is in need of protection must immediately report this to a child protection social worker. This is legislated in B.C.'s Child, Family, and Community Services Act (CFCSA). Unless you knowingly provide false information, you cannot be held liable for making a report.

Midwives have a duty to report a child in need of protection and to be aware of when to report. Midwives always consider whether children are potentially at risk from a parent/caregiver with a mental or physical condition which may affect their ability to provide care. If  a midwife is unsure if the situation requires reporting  they collaborate with other members of the health care team. If a child is in immediate danger, call 9-1-1. Do not assume that someone else has or will report.

Failure to report a child who is believed to be in need of protection is a criminal offense.

Duty to report​​ vs. confidentiality

The duty to report child mistreatment overrides the confidential requirement of the client/care giver relationship to the extent required to provide the necessary  information to make the report. Any information that is not required to provide a report remains confidential. Once the concern has been reported, client charts are subject to normal confidentiality requirements, meaning that documentation can only be provided with the client's consent, or in accordance with law.

Resources

Each BCCNM designation has its own set of Standards of Practice.

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Vancouver, BC  V6C 1S4
Canada

info@bccnm​.ca
604.742.6200​
​Toll-free 1.866.880.7101 (within Canada only)