What to do if a child discloses abuse

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What to do if a child discloses abuse

Post by miriam » Wed Apr 04, 2007 12:56 am

This is a frequently asked interview question, but also a topic that is important to know if you come into direct contact with children.

To me there are three parts to the answer I would give. The first is having set the right ground rules, so the client knows the limits to confidentiality, the second is being able to act on a child protection procedure - such as knowing who to inform, and the third is the immediate risk assessment and contracting, such as keeping the client in the building until you feel the immediate risk has been addressed, or making a deal with them that they won't do anything that harms themselves until you see them again, etc.

So, what are the limits to confidentiality when working with a child?

If a child is old enough to give or withold consent meaningfully (this used to be called "Gillick competent") then you'd contract with them about how you'd share the contents of therapy. It would be pretty rare to share nothing with parents, and only really viable with a teenager who attends alone. With younger children it is much better practise, and much more common to involve the parents in the work, either in the room or through periodic family sessions.

The exception to confidentiality, which you'd make explicit in the first session with any child and repeat periodically, is that you can't keep it to yourself if the child discloses abuse to themselves or anyone else, or a risk of harm in any form including suicidal ideation/intent for themselves or any other child. This is also true if an adult discloses abuse - if they name an abuser you have a duty to report it if they have (or are likely to have) contact with children. For example, if a mother discloses sexual abuse from her step-dad which her mother didn't believe but still takes her children to visit them you have to report this. Unless there is an immediate risk involved in doing so, you should also tell the person, and if it is a child, their parent, what you are going to report and why, rather than doing it behind their back.

When these concerns arise you need to report it to your supervisor, or if they are not available, the most senior available clinician in the building. They can then help you to put the appropriate report in to social services, and manage any immediate risk, and in the event of risk of suicide or a present risk of serious harm from another person this would normally need to be done even before you finish the appointment.

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Content checked by Will on 26/2/12.
Last modified on 26/2/12.

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