Designing a Service Delivery Structure for Timely and Professional Response to the Care, Safety and Protection Needs of Children who

are Being Maltreated or at Risk of Being

Moving Towards a Systems-Based Approach to Child Protection

Berjaya Times Square Hotel

Kuala Lumpur, November 20-22, 2012

are Being Maltreated or at Risk of Being Maltreated

Bernadette J. Madrid, MDDirector, Child Protection Unit

Philippine General Hospital- University of the Philippines&

Executive DirectorChild Protection Network Foundation, Inc.

Objectives of the Workshop

1. Discuss the care, safety and protection needs of maltreated children and children at risk.

2. Enumerate the different delivery structures of services in the care continuum for maltreated children and children at risk within a child children and children at risk within a child protection system.

3. Identify the challenges faced by low and middle-income countries in the delivery of these services.

4. Discuss possible solutions to practical problems faced by front line professionals.

Article 19

Protection fromParental Guidance

& Evolving Capacities

Birth registration (art.7)

Social Security (art.26)

Education (art.28)

Protection from

Risk Situations

Right to Health(art.24)

Refugee

Children (art.22)

Children with

Disabilities (art.23) Indigenous and

Minorities (art.30)

The Right to Protection and CRC

General principles of the CRC

for the realization of Article 24

Policy and

Programmatic

Standards for the

Realization of

Article 24

Non-Discrimination (art.2)

Protection from

Violence

Life, Survival and Development (art.6)

Best Interest of

the Child (art.3)

Respect for the Views

of the Child (art.12)

& Evolving Capacities

of the Child (art.5)

Privacy and

Confidentiality (art.16)

Access to Appropriate

Information (art.3)

Drug Abuse (art.33)

Sexual

Exploitation (art.34)

Abduction, Sale

& Trafficking (art.35)

UNHCRThe UN Refugee Agency

Wulczyn F, Daro D, Fluke J, Feldman S, Glodek C, Lifanda K

Adapting a Systems Approach to Child Protection: Key concepts & Considerations, 2010

Issue-Driven

Child

Trafficking

Defines the system

Justice for

Children

Sexual

Exploitation

in travel &

tourism

Defines the system

ETC.

Major Changes in Child Protection

Approaches

• A recognition of the often complex set of

issues facing families requiring more

collaborative approaches to keeping children

safe and well.safe and well.

• Bigger focus on intervention and prevention.

Public Health Approach

The Care Continuum: INTERVENTION

• Use of Media

• Training on

EARLY DETECTION OR SUSPICION

Surveillance strategies

Detection strategies

Mobilizing child care Training on

recognition and

reporting of

abuse

Mobilizing child care

professionals

Public awareness programs

Awareness programs for children

The Care Continuum: INTERVENTION

• Mandatory

reporting for

health

professionals

REPORTING & REFERRAL

Reporting mandates &

guidelines

Reporting & Referral Network

professionals

The Care Continuum: INTERVENTION

• Child Protection

Units (CPU)

MULTIDISCIPLINARY

EVALUATION & DIAGNOSIS

Coordinated multidisciplinary

evaluation

Nationwide regional WCPU

system

Interdisciplinary suspicious

death review team

Professional specialty

consultation

The Care Continuum: INTERVENTION

• Goals:

Physical Health

Mental Health

Safety

TREATMENT, RECOVERY &

REINTEGRATION CARE

Integrated multidisciplinary case

management

Nationwide WCPU system Safety

Development

Nationwide WCPU system

Reintegration care

�� Preparing family and Preparing family and

communitycommunity

The Care Continuum: INTERVENTION

• Adolescent sexual

offenders

• Guardian ad litem

ADMINSTRATION OF JUSTICE &

THE LAW

Offender case management

Child Support during legal

proceedings• Guardian ad litem

proceedings

Medical profession

responsibilities��Testifying in court Testifying in court

The Care Continuum: PREVENTION

INVESTING IN CHILDREN

Empower children

Create child friendly educational

system

Utilize education as a tool to

break the cycle of abuse

Increase access to health

services

The Care Continuum: PREVENTION

• Services for

children with

DEVELOPING FAMILY

SUPPORT

Family support strategies

& advocacy

children with

disabilities

• Services for

battered women

Link child abuse

prevention programs with

risk factor reduction

programs

Identify & manage

spousal abuse

The Care Continuum: Prevention

• Working with local

gov’t and villages

BUILDING COMMUNITY CHILD

RIGHTS INFRASTRUCTURE

Establish and support safer

neighborhoods

Mobilize local gov’t to

strengthen community-family strengthen community-family

interaction

Establish community volunteer

networks

Public education

��

The Care Continuum: GOVERNANCE

REALIZING A NATIONAL AGENDA

Oversight of child protection

services

Resource coordination &

collaborative planningcollaborative planning

Advocacy for child protection

issues

The Care Continuum:

TRAINING & RESEARCH

• Train as a team:

doctors, social

workers, police

SPECIALIZED TRAINING FOR CARE

CONTINUUM PROFESSIONALS

Multidisciplinary training

Discipline Specific

• Child Protection

Specialist Training;

• Undergraduate

curriculum for

MDs, social

workers, etc.

Discipline Specific

Opportunities for continuing

education

The Care Continuum:

TRAINING & RESEARCH

ADVANCING THE PROFESSION

Oversight of Care Continuum

Professionals

Facilitated information

dissemination

Child Protection

Databasedissemination

Cooperative database &

resource network

Research initiatives on best

practices & infrastructure needs

The Philippine General Hospital

Child Protection Unit:

An Interdisciplinary Approach to

Child Protection

University of the Philippines Manila

Child Protection Outcomes

1. Safety

2. Legal Protection2. Legal Protection

3. Health

4. Normal Development

The CPU Multidisciplinary Team

•Physicians

•Social Workers

•Mental Health Professionals

•Nurse•Nurse

•Forensic Pathologist

•Lawyer

•Police

•Victim Advocates

What happens when a child is brought to

the Child Protection Unit?

Intake

Forensic Interview

PE with documentationPE with documentation

Safety Assessment

Mental Health Service

Home visit / Risk Assessment

Case Management

Medical Services

SAFETY ASSESSMENT

MEDICAL EXAM

FORENSIC INTERVIEW

INTAKEMEDICAL SERVICES

•Medico-Legal Evaluation

•Diagnosis & Treatment of

STIs

•Developmental Assessment

COURT TESTIMONY

CASE MANAGEMENT

CASE CONFERENCE

RISK ASSESSMENT

MENTAL HEALTH SERVICES

SAFETY ASSESSMENT

•Medico-Legal Testimony

•Continuity of Care & Well-

Child Services

Social Services

SAFETY ASSESSMENT

MEDICAL EXAM

FORENSIC INTERVIEW

INTAKESOCIAL SERVICES

•Safety & Risk Assessment

•Case Management

•Educational & Livelihood

Assistance

COURT TESTIMONY

CASE MANAGEMENT

CASE CONFERENCE

RISK ASSESSMENT

MENTAL HEALTH SERVICES

SAFETY ASSESSMENT•Parenting Classes, Parent Support

Group

Mental Health Services

RISK ASSESSMENT

MEDICAL EXAM

FORENSIC INTERVIEW

INTAKEMENTAL HEALTH

•Mental Health Screening

•Individual & Family Therapy; Abuse-

specific therapy, and therapy for children

with problematic sexual behavior

•Group Work

COURT TESTIMONY

CASE MANAGEMENT

CASE CONFERENCE

RISK ASSESSMENT

MENTAL HEALTH SERVICES

RISK ASSESSMENT

•Forensic Psychiatric Evaluation & Court

Testimony

with problematic sexual behavior

• Legal counseling

• Preparation of legal documents

• Representation of patient in

preliminary investigation hearings

Legal Services

preliminary investigation hearings

• Kids in Court

• CASA-GAL

• On-site case filing

• Forensic interview

• Preliminary investigation hearings

• Crime investigation

Police Services

• Crime investigation

• Submission of police reports for board of

claims

• Training of other police officers

Characteristics of Primary Health Care

• Accessible

• Acceptable

• Continuity of Care

• Affordable

• Accountable

Levels of WCPUs

Personnel Services

All level III

trained

personnel

+

Additional trained

physician and

social worker

Level III

medical

services

+Sub-specialty

consultations and

other support

services

Level IVLevel IV

Level ILevel IBasic care services;

Refers to WCPU for complex cases

CPU Referral Units : Trained Municipal

Health Officers and social workers

Level II trained personnel

+Trained police investigation officer

and/or

Mental health professional

Level II medical services

+Social worker home visit

Investigation +/or

mental health care

Specialty consultation

CPMIS

Trained physician

Trained registered social worker

Acute medical treatment

Medico-legal examination

Social worker intervention with safety

and risk assessment

Peer review

Documentation and record-keeping

Expert testimony in court

Level IILevel II

Level IIILevel III

Child Protection

Network 2012

54 CPUs (35 provinces & cities)

covering

17,663,786

(47.7%)

children

Child Protection

Network 2014

85 CPUs (50 provinces & cities)

151 CPU Referral Units

coveringcovering

28,676,112

(75.8%)

children