Rules on Procedures in Child Protection

The document is aligned with the document of the Polyclinic for the Protection of Children and Youth of the City of Zagreb (poliklinika-djeca.hr)

Rules of Conduct in Child Protection (Child Protection Policy)

The purpose of this document is to present the rules of legally, professionally and ethically based practice in BHIDAPA, with the aim of protecting children exposed to violence, abuse and neglect or at risk, and in their best interest

It is based on:

• on the applicable legal regulations in Bosnia and Herzegovina and the Convention on the Rights of the Child
• on relevant knowledge about all forms of abuse (physical, sexual, emotional), neglect and exposure to domestic and peer violence among children and young people, as well as the consequences for children.
• on professional knowledge about the traumatization of children and young people, as well as evidence-based knowledge about diagnostic and treatment/therapeutic work with traumatized children, young people and their families.

BHIDAPA was founded with the aim of protecting children, young people and families, through the following activities:

• education of professionals in the field of child and adolescent integrative psychotherapy and psychotherapeutic counseling, techniques and skills in working with children through lectures, workshops and training in accordance with European standards;
• interdisciplinary diagnostics and treatment (psychiatrists, psychotherapists, clinical psychologist, pediatrician, social pedagogue, special education teacher/speech therapist, social worker, lawyer)
• kontinuirane supervizije stručnjaka koji rade sa djecom, mladima i obiteljima provođene od ovlaštenih supervizora i edukatora regulirano od EIATSCYP (European Interdisciplinary Association for Therapeutic Services for Children & Young People); EAP (European Association for Psychotherapy);
• protection measures for traumatized, abused and neglected children, children who are at risk of abuse and neglect, and children and young people in conflict with the law, with the aim of establishing and implementing multidisciplinary diagnostics and team planning of the best possible treatment for each child and parents with coordinated cooperation with other mental health professionals and intersectoral cooperation in the best interest of the child and their well-being
• publishing scientific journals, manuals, brochures, promotional materials, with the aim of promoting children’s rights, health determinants, and sensitizing society, especially professionals, about the seriousness of the problem of child abuse, the possibility of recognition and providing appropriate help and support, and raising public awareness about the importance of preserving and improving the mental health and quality of life of children, adolescents and families
• Orientation towards the development or promotion of psychotherapeutic science in accordance with European standards;

BHIDAPA’s activities are carried out on the basis of existing legal regulations and professional standards, scientific knowledge, experience and practice, following the model and with the support of the Polyclinic for the Protection of Children and Youth of the City of Zagreb, and cooperation with other institutions of the system, based on which the child is provided with a specialized team approach to the most efficient and humane solution to their difficulties.

The applicable legal regulations in Bosnia and Herzegovina on which the work of the Association and Institute is based are as follows:

• Convention on the Rights of the Child,
• Convention for the Protection of Human Rights and Fundamental Freedoms,
• European Convention on the Exercise of Children’s Rights,
• Convention on Human Rights and Biomedicine and other regulations and protocols that establish procedures for contact with children, as well as positive experiences of other organizations and institutions in working with children,
• Constitution of BiH, and a series of laws dealing with this area (Law on Protection from Domestic Violence, Family Law, Criminal Law, Law on Protection of Patient Rights, Law on Health Care, Law on Medical Practice, Law on Personal Data Protection),
• BHIDAPA Statute, which, among other things, regulates the practice of the Ethics Committee,
• Protocol on procedures in cases of sexual violence which defines standardized procedures for the protection of victims of sexual abuse for all professionals of various profiles from various institutions,
• Protocol on procedures in cases of child abuse and neglect,
• Protocol on procedures in cases of domestic violence,
• Council of Europe Convention on the Protection of Children against Sexual Exploitation and Sexual Abuse,
• Directive 2011/93/EU of the European Parliament and of the Council of 13 December 2011 on combating the sexual abuse and sexual exploitation of children and child pornography,
• Directive 2012/29/EU of the European Parliament and of the Council of 25 October 2012 establishing minimum standards on the rights, support and protection of victims of crime.

BHIDAPA is also a signatory member of EIATSCYP.

The purpose of BHIDAPA is:

• to ensure effective, timely and well-coordinated support for children and their families;
• to ensure respect for the best interests of the child;
• promotion of children’s rights;
• promotion of health determinants and well-being of children;
• to ensure protective measures against abuse and neglect, through recognition, education and response to child abuse and neglect, as well as prevention of violence against children, in accordance with the law.

These postulates, as well as respect for legal and professional standards, apply to and relate to every employee/volunteer, student of BHIDAPA.

Operation of the BHIDAPA Therapeutic Center

Diagnostic and therapeutic work

The Center ensures a specialized team approach to children, young people and parents. The multidisciplinary team consists of: psychotherapists, psychologists, clinical psychologist, psychiatrists, social pedagogue, special education teacher and lawyer. Through team professional work, the child is approached using the specific knowledge and skills of each professional, the work is carried out through multidisciplinarity, it is coordinated for the greater well-being of the child, and each of the professionals directly or indirectly contributes to better diagnostics and determination of treatment according to the individual needs of each child.

Case supervision is also conducted in BHIDAPA under the leadership of psychiatrists and psychotherapists.

Other Activities

The work of BHIDAPA Centers encompasses preventive activities at all three levels.

• The primary level includes providing a specialized educational program for acquiring academic and professional skills in the field of child and adolescent integrative psychotherapy and counseling. The primary level of educational prevention is also achieved by raising public awareness among parents and children, professionals working with children and the wider public, which also includes social structures that have the opportunity to contribute to child protection, through professional seminars, workshops, and training programs.
• The secondary level of prevention is achieved by professionals of the Interdisciplinary Therapeutic Center for the Protection of Children, Young People and Families through continuous education, individual work, supervision, daily work with children and families who, due to personal characteristics or unfavorable conditions of growing up, are at increased risk of exposure to various forms of abuse or neglect.
• The tertiary level refers to treatment with children who have experienced a certain form of violence with the aim of minimizing the consequences and preventing revictimization by focusing on their recovery.

All of the above activities are realized through:

• Education of professionals
• Team professional work and supervision
• Crisis intervention team
• Research and scientific work
• Raising public awareness and publications

Course of Action

Protocol for procedures in direct work with children through diagnostics and treatment in situations that require child protection due to suspicion of abuse, neglect or exposure to violence.

1. Arrival at the Center

The child comes accompanied by a parent/legal guardian: on the initiative of the parent/guardian or on the recommendation of the competent physician, Center for Social Welfare, and on the recommendation of other institutions (school, kindergarten, home, NGO, etc.).

2. Assessment

The process begins with the first conversation with a professional from the multidisciplinary team, who further assesses the condition and the need for involving other professionals in the team. In case of suspicion of abuse, neglect, domestic violence, etc., the urgency of admission is assessed by evaluating the child’s safety

3. Conversation

The conversation is conducted by speaking with the person who came to accompany the child and with the child themselves. If possible, in case of suspicion of abuse, the conversation with the child and parent is conducted separately, but always taking into account the best interests of the child and reducing the risk and stressfulness of the situation for the child. Procedures in the stated situation are the responsibility of mental health professionals and are in accordance with the rules of professional conduct with children of different ages and individual characteristics and needs. The first conversation also includes providing psychological first aid to the child and parent, due to the possible traumatic nature of events to which the child was exposed. After the conversation, the parent is informed about the further action plan. The child is also informed in a manner appropriate to their developmental status and in accordance with the child’s right to information according to the Convention on the Rights of the Child.

4. Collection of documentation

Collection of relevant documentation is most often in cooperation with the Center for Social Welfare, after the first meeting (by sending a notice with a request for provision of information). Cooperation with other institutions is possible in order to protect children and obtain relevant information (Center for Social Welfare, police, schools, preschool institutions, other health institutions, etc.).

5. Notification

If during the conversation or during the process, data is obtained that indicates suspicion that the child was exposed to some form of domestic violence (directly or indirectly), the professional notifies the competent institutions: Police Department and Center for Social Welfare according to the child’s place of residence, and sometimes the State Prosecutor’s Office.

When establishing suspicion, professionals are guided by data obtained through the application of professional knowledge and competencies in working with the child and families.

For this purpose, professionals of the multidisciplinary team conduct forensic interviews and forensic evaluations, or elements of these procedures as needed, for which they are specially trained.

The notification sent to the competent institutions contains general information about the child, the reason for coming to BHIDAPA Association and the name of the person or the name of the institution that referred the child.

The course of the process so far and the findings obtained (child’s statements), any injuries, and possibly other relevant data based on professional assessment are also described.

In cases where suspicion of the child’s exposure to violence is not established with certainty (young chronological age of the child, the child’s developmental limitations or condition, refusal to talk, family factors, etc.), but further risks to the child are observed, the competent institutions are also notified with an appropriate recommendation.

If, during the first contact with the child, it is determined that the child is exposed to current danger, as well as possible lack of protection outside the Association premises, the professional immediately establishes contact with the competent institutions (Center for Social Welfare, police) due to the urgency of action to protect the child.

6. Processing

The professional who initiated the processing informs the team leader and other team members about the data obtained so far and the processing carried out, as well as the established indications for team processing that have been agreed upon. During the joint meeting, with the leadership and coordination of the team, additional joint decisions are made and agreements are reached on the further implementation of diagnostics and treatment planning for each child. The parent/legal guardian and the child themselves should be informed about the planned treatment in a manner appropriate to the developmental age.

7. Informing the Guardian and the Child

After the processing is completed or during its course, the parent/guardian is informed about its course and results, as well as recommendations for further action. The child receives information in accordance with their developmental age.

8. Joint Findings and Opinion

Each team member prepares their own findings and opinion, which also contains an opinion and recommendation for further action and possible treatment of the child and their family. The joint findings and opinion contains information about the child’s somatic/physical status, their developmental and intellectual characteristics, and the diagnostic psychological profile obtained, the conditions and dynamics in which the child is growing up, characteristics of the child’s social and emotional development and competencies, the degree of traumatization, possible psychopathology and difficulties, personal and family risk factors, possible suspicion of witnessing and exposure to abuse/violent behavior in the family or other environment.

The opinion contains a recommendation for inclusion in one of the treatments (or several of them) at the Center or another institution. The findings also contain a recommendation on the need to include parents in counseling or treatment, as well as for possible inclusion in the processing of siblings of the child being processed if their risk of traumatization is assessed. The findings also contain a possible recommendation for further protection of the child.The findings and opinion are issued to the child’s parents unless a possible conflict of interest between the child and parents is determined, in cases where the parent is the source of the child’s traumatization and could misuse the findings for further pressure on the child. Then we send the findings to the competent Center for Social Welfare, guided by the best interests of the child and the ethical code of the involved professions.

If there is a suspicion that the child witnessed domestic violence or was exposed to it themselves, the findings are sent to the competent Center for Social Welfare, and a notification to the police (if it was not sent immediately upon starting the processing). The findings can be sent to the police and court in accordance with the law, upon their written request.

9. Cooperation With Other Institutions

In cases where parents are not willing to cooperate during the processing, assistance in the procedure is needed from the competent Center for Social Welfare. For the child and their further protection, avoiding repeated questioning has proven to be particularly important, as it contributes to possible further traumatization.

Sometimes it is necessary for the competent Center for Social Welfare to take certain measures or for court decisions to be made in order to provide the child with the necessary protection and create safe and stable conditions for their inclusion in appropriate treatment. Cooperation is often necessary also because parents refuse to participate in treatment or counseling, especially when they neglect their own role and parental responsibility.

In all the above cases, the professional of the Center for the Protection of Children, Young People and Families notifies the competent Center for Social Welfare while requesting cooperation in the procedure.

10. Treatment of Children Exposed to Trauma

The multidisciplinary approach is the most favorable model for both determining the child’s needs and their further treatment. The most effective methods and therapeutic approaches based on evidence of effectiveness are used in treatment with children: humanistic approaches (integrative psychotherapy, gestalt therapy, art therapy, play therapy, EMDR), TF-CBT and the psychodynamic model. The parent/guardian is regularly included in the treatment of children through counseling work, as it has been shown that the support of family and close people is a first-order protective factor for the child.

Contrary to the long-held view that the child should not be included in treatment before the end of the court process, based on contemporary professional knowledge, and guided by the Convention on the Rights of the Child and the norm established in it about the best interests of the child, “forensically sensitive treatment/therapy” has been designed in the professional community. This treatment approach is focused on beginning the recovery of an abused or neglected child who shows signs of trauma. In such cases, it is justified for treatment to begin even before the court process is concluded, because waiting for it to finish is too long for the child and family who need a quicker intervention. This approach has proven to be justified, and often during treatment the child also receives additional support due to exposure to stressors that accompany the procedure (court examination, family difficulties related to the functioning of the system, etc.).

Rules

All involved professionals are obligated, based on the Law on Health Care, to keep as a professional secret everything they know about the patient’s health condition.

For each employee, the criminal record is checked at the Ministry of Justice of BiH, based on the Law on Legal Consequences of Conviction, Criminal Record and Rehabilitation).

Each new employee or volunteer employee, before starting work, is familiarized with the regulations important for the work of BHIDAPA, acts and the manner of performing activities by the director, legal service and head of activities.

Hierarchical Responsibility

BHIDAPA Centers are organized on a hierarchical principle based on applicable regulations, which implies professional responsibility to a superior person and service.

Ethical Principles in Working With Children and Families

All professionals are obligated to respect the ethical code of their profession and the ethical code of research with children. The confidentiality of information is protected except in cases where it is necessary to protect the child’s rights, about which both children and families are informed in accordance with the law.

Careful attention is paid to protecting the privacy of children and their families in the storage and safekeeping of documentation.

Informed consent of parents/guardians is regularly sought in case of recording or use of documentation for educational purposes, taking into account the protection of the child’s privacy, as well as when children participate in research.