Part 3: Identifying and responding to concerns about children 99 National Guidance for Child Protection in Scotland 2021 Version 1.0 September 2021 Health assessment and medical examination Outline guidance on purposes, components and processes. Purpose 3.68 The health assessment of a child for whom there are child protection concerns aims: • to establish what immediate treatment the child may need • to provide a specialist medical opinion on whether or not child abuse or neglect may be a likely or unlikely cause of the child’s presentation • to support multi-agency planning and decision-making • to establish if there are unmet health needs, and to secure any on-going health care (including mental health), investigations, monitoring and treatment that the child may require • to listen to and to reassure the child • to listen to and reassure the family as far as possible in relation to longer-term health needs 3.69 The decision to carry out a medical assessment and the decision about the type of medical examination is made by a paediatrician informed by multi-agency discussion with police, social work and other relevant health staff. Through careful planning, the number of examinations will be kept to a minimum. The decision to conduct a medical examination may: • follow from an IRD and inter-agency agreement about the timing, type and purpose of assessment • follow when a person presents to health services. This includes the possibility of self- referral for victims of rape and sexual assault who are over 16 years old as described below 3.70 The main types of medical examination that may be undertaken within the Child Protection process are: a. Joint Paediatric Forensic Examination (JPFE). Examination by a paediatrician and a forensic physician. This is the usual type of examination for sexual assault and is often undertaken for physical abuse, particularly infants with injuries or older children with complex injuries. b. Single doctor examinations with corroboration by a forensically trained nurse. These are sexual assault examinations undertaken for children and young people aged 13-16. In some areas/situations a JPFE would occur, and in all areas/situations JPFE should be considered. c. Specialist Child Protection Paediatric/Single Doctor/Comprehensive Medical Assessment. This type of examination is often undertaken when there is concern about neglect and unmet health needs but may also be used for physical abuse and historical sexual abuse. Comprehensive medical assessment for chronic neglect can be arranged and planned within localities when all relevant information has been collated. However there may be extreme cases of neglect that require urgent discussion with the Child Protection Paediatrician.