Part 3: Identifying and responding to concerns about children 100 National Guidance for Child Protection in Scotland 2021 Version 1.0 September 2021 3.71 All medical examinations/assessments are holistic, comprehensive assessments of the child/young person’s health and developmental needs. There may be variations in who undertakes medical examination, and the purpose of the examination must be clear prior to the examination (usually discussed at IRD or at time of referral for the examination) to allow for a clinician with the appropriate skill set to undertake the assessment. 3.72 In some parts of Scotland, where victims of rape or sexual assault are aged 16 and over, they are able to self-refer for a forensic medical examination without first making a report to police. Once commenced the Scottish Government Forensic Medical Services (Victims of Sexual Offences) (Scotland) Act 2021 will extend consistent access to self- referral services across Scotland for those aged 16 and over. Professional judgement is required as to whether following self-referral, a forensic medical examination is in the person’s best interests. This includes clinical and non-clinical considerations. Even when an FME is not provided, the need for healthcare support and treatment must be considered. A Clinical Pathway for Children and Young People and a forthcoming Self- Referral Protocol will provide further guidance. 3.73 Specialist paediatric or Joint Paediatric Forensic Examination (JPFE) is appropriate when: • the child requires a specialist assessment or treatment from another department (for example, multiple fractures, signs of abusive head trauma) • the account of the injuries provided by the carer does not provide an acceptable explanation of the child’s presentation • the result of the initial assessment is inconclusive and a specialist’s opinion is needed to establish the diagnosis • lack of corroboration, for example by way of a clear statement from another child or adult witness, indicates that forensic examination, including the taking of photographs, may be necessary to support criminal proceedings against a perpetrator, and legal processes to protect the child • the child’s condition (for example, repeated episodes of unexplained bruising) requires further investigation • child sexual abuse is suspected 3.74 A comprehensive medical examination for neglect can be arranged and planned for 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. 3.75 Significant new information may arise from a medical examination that requires the reconvening of an IRD.