Responding to female genital mutilation: multi-agency guidance

6. Responding to girls at risk of, or who have already undergone, FGM: individual agencies

1. NHS: guidelines for all healthcare staff

All healthcare workers, including all nurses, midwives and doctors, have a duty of care to girls and women who are at risk of FGM, or who have already had the procedure. The Chief Nursing Officer and Chief Medical Officer for the Scottish Government have written to all healthcare professionals highlighting this obligation and their responsibility to understand and respond to actual and potential FGM ^[32] .

Women and girls at risk of, or who have already undergone, FGM may present in various settings such as obstetric and midwifery services, cervical smear screening, sexual and reproductive health clinics, travel clinics, paediatrics, urology, gynaecology, mental health services, A&E, dermatology, out-of-hours primary care services, Scottish Ambulance Service and GP practices.

Treatment depends on the symptoms, the type of FGM, and whether or not the woman is pregnant. FGM is often identified during antenatal care or delivery. Women with gynaecological symptoms such as pelvic or genital pain, incontinence or prolapse, and menstrual dysfunction may need referral to services such as general gynaecology and urogynaecology, or have their care provided in one service if available.

Practitioners should assess a woman/girl holistically and explore her medical, support and protection needs. They should refer to specialist services, including mental health services, as necessary.

Any healthcare worker who obtains information about FGM should record their concerns in the patient’s records.

Healthcare workers should routinely share information about any concerns with other main professionals in a girl’s life. In practice, this means the girl’s health visitor or head teacher/guidance teacher depending on the girl’s age, the GP and school nurse (as appropriate).

Risk can only be considered at a particular moment in time. Healthcare professionals should take the opportunity to continue their discussions about FGM throughout the standard delivery of healthcare. If, for example, a midwife has passed information to a health visitor/ GP about a woman who has undergone FGM, the health visitor/ GP should discuss this at the next appointment with the woman/child. They could use the relevant section of this guidance to help structure the discussion now and on a continuing basis if required (see FGM risk assessment guidance in Appendix 4).

As part of any discussion with the woman and/or appropriate family members, health practitioners should:

• Clarify that FGM is illegal in Scotland.
• Explain the health consequence of FGM.
• Ensure the woman/family member understands what action, if any, will be taken.
• Ensure the woman/family member understands that information will be shared with colleagues and other agencies as appropriate.
• Provide information and signposting to other services as needed.

Child protection advisers can help to assess the threshold for child protection proceedings, data holding and information sharing across systems and agencies. Healthcare staff should consult with them when deciding on any course of action, and give them details of all risk assessments. This will support action consistent with local child protection procedures.

See flowcharts in Appendix 5.

Maternity staff

Identifying FGM as early as possible is critical to effective maternity care, preventative strategies and protecting girls. The booking appointment/visit is the most suitable time to ask about FGM, during routine taking of a woman’s case history. Several health boards undertake routine enquiry of FGM with all pregnant women, recognising that it is not possible to identify this through country of origin alone.

However, this might not occur, or a woman might present much later in the pregnancy, or FGM may not become apparent until labour is underway. So, at any stage in the pregnancy, midwives may need to discuss FGM with a woman and assess risk.

If discussion with the woman (and other parent if appropriate), as outlined in Appendix 4, indicates that there is imminent risk of FGM following the birth then maternity staff should instigate child protection procedures.

If maternity staff think there may be risk of FGM following the birth, they should discuss this with the child protection adviser, the health visitor and the parent(s). An IRD should then be arranged.

If maternity staff have no concerns they should record the outcome of the risk assessment in the woman’s notes and in the child’s public health record.

In all cases, maternity staff must share information with the GP, child protection adviser and health visitor and record this in the woman and the child’s health records.

Good Practice
In NHS Lothian, from March 2015 110 women have been identified as having experienced FGM. The specialist midwife has met with them to discuss their needs and ensure their care is tailored to these. She also discusses potential risk factors with them. To date only 8 cases have required an Interagency Referral Discussion meeting.

Health visitors

Health visitors are in a unique position to recognise infants and girls at risk of FGM and to take protective action. They are often the only professionals in contact with a family with pre-school children. They generally see pre-school children at routine health surveillance checks and immunisations. Also, health visitors usually contact and visit all families with pre-school children new to an area.

Health visitors are also well placed to collaborate, support and refer as part of a multi-professional team.

Health visitors are responsible for discussing FGM and gathering information if there is no previous discussion or risk assessment on record.

If the child is new-born, maternity service staff should already have gathered sufficient information for assessing risk to the baby. If not, or there is new information, health visitors may need to gather information as if the family were new to the area. Health visitors should be aware that FGM is a ‘protected characteristic’ in the child health record.

If healthcare staff have already gathered information about a woman who has undergone FGM, health visitors should be able to read what is on record. Health visitors should copy the information into the child’s health records, and provide this for the GP’s notes. If there are other girls in the family, then health visitors should copy the information into their notes, and advise the GP of this.

If there is concern about imminent or significant risk, health visitors should instigate child protection procedures immediately.

If information is incomplete or there are ongoing concerns that a baby girl may be at risk, health visitors should consult the child protection adviser for advice and arrange an IRD. This will enable practitioners to consider collectively information held by police, social work, health and possibly education, and to assess risk. The outcome of any discussions should be recorded.

If there are no indications of risk, the heath visitor should be alert to any changes in circumstances that may alter this situation, and be prepared to revisit the risk assessment.

School nurses

School nurses are in a good position to reinforce information about the health consequences of, and the law about, FGM. Specialist school nurses may be most suitable for children over age five, as most families with children of this age will have no contact with other professionals such as social workers and health visitors. Teachers are not expected to have such discussions with parents. FGM-trained school nurses may carry out the required health discussions, participate in risk assessments and share information as appropriate.

(See also under Education.)

GPs, treatment room and practice nurses

GPs, treatment room and practice nurses should be vigilant for health issues such as recurrent urinary tract infection which may indicate that FGM has been performed.

When families ask for vaccinations for foreign travel, practitioners have an opportunity to talk about FGM, the health risks and the law. Discussions could also include forced marriage as these issues are sometimes linked. Practitioners should record what advice or leaflets they give.
( http://www.gov.scot/Topics/People/Equality/violence-women/FGM/Letter)

If a woman from a community affected by FGM attends for a cervical smear, this is also an ideal opportunity to talk about FGM and associated health concerns. It is also important to follow up non-attendance for a smear particularly for women who have undergone Type 3 FGM and who are unlikely to attend.

If a professional is concerned about a parent’s attitude towards FGM, they should discuss this with a relevant senior colleague and local child protection adviser, and refer if necessary. The outcome of the discussion should be recorded.

GPs are responsible for coding FGM using the appropriate Read or equivalent SNOMED codes. This is extremely important, as it is the only way of keeping this information with a patient for life, thereby ensuring that her children can be identified as potentially at risk.
http://www.sehd.scot.nhs.uk/cmo/CMO(2014)19.pdf

GP practices serving student populations should be particularly vigilant. In NHS Lothian, for example, postgraduate students from FGM-affected countries have registered with young children who have had, or are at risk of, FGM.

Staff in emergency departments and walk-in centres

Staff in emergency departments and walk-in centres should know the risks associated with FGM so that if girls/women from communities in which FGM is performed attend with urinary tract infections ( UTI), menstrual pain, abdominal pain or altered gait, assessment of risk is included in the clinical assessment. Staff should document this. If a girl has undergone FGM, staff should consult with relevant senior staff and the child protection adviser to initiate child protection procedures.

Sexual and reproductive health ( SRH) services

Staff in SRH services are ideally placed to enquire about FGM and to refer on if necessary. If a young woman (under 18) has undergone FGM, staff should ascertain where and when this occurred, and arrange an IRD to consider her needs and whether child protection procedures are required. Staff should also check whether there are other girls in the immediate or wider family who are at risk and follow the process outlined at the beginning of this section if they have any concerns.

Good Practice
NHS Greater Glasgow and Clyde has an integrated care pathway on FGM. Routine enquiry of FGM is carried out during pregnancy and women referred to the specialist ‘Special Needs in Pregnancy Services ( SNIPS). A clear protocol and referral process is in place for women seeking revision who are seen at a ‘one stop’ clinic in Stobhill Hospital. To date 41 revision procedures have been carried out.

Staff in assessment services for asylum seekers and refugees

Some health boards have dedicated services which conduct initial health assessments for asylum seekers and refugees. These assessments include family and personal history (including family trees) to find out whether other family members are in the UK. The assessment (for women) also covers gynaecological issues and history of violence, trauma and/or torture, which should include FGM. Women relocated from abroad through international programmes e.g. from camps in Libya, Europe etc. should also be asked about FGM as part of their health assessment.

Healthcare staff who are conducting such assessments should record whether a woman has undergone FGM and the type, if known. They must also record that they have spoken to the woman to ensure she understands that FGM is illegal in Scotland and given her a leaflet in a language which she can read which explains the risks of FGM, the law and local support services.

Staff should refer a woman to other services if necessary and share relevant information with other health professionals such as the GP and health visitor. If there are female children, staff should consult with a relevant senior colleague, the child protection adviser and the relevant social work team to determine whether an IRD is required.

Guidance documents for health professionals

Child Protection Guidance for Health Professionals (Scottish Government, 2013) (revision of ‘The Pink Book’): http://www.gov.scot/resource/0041/00411543.pdf

Female Genital Mutilation: caring for patients and safeguarding children (Guidance from the British Medical Association, July 2011):

https://www.bma.org.uk/-/media/Files/PDFs/.../Ethics/femalegenitalmutilation.pdf

Royal College of Nursing - FGM educational resource (2006):

https://www2.rcn.org.uk/__data/assets/pdf_file/0010/608914/RCNguidance_FGM_WEB2.pdf

Royal College of Obstetrics and Gynaecology FGM guidelines:

https://www.rcog.org.uk/globalassets/documents/guidelines/gtg-53-fgm.pdf

RCM, RCN, RCOG, Equality Now, UNITE (2013) ‘Tackling FGM in the UK: Intercollegiate Recommendations for identifying, recording, and reporting. London: Royal College of Midwives

https://www.rcog.org.uk/globalassets/documents/news/tackingfgmuk.pdf

2. Police Scotland: guidelines for police officers

Reports that a girl or woman has been subject of FGM or concerns that a girl or woman may be at risk of FGM can come to the attention of officers and members of police staff from various sources, including direct reporting by a girl or woman; a named or anonymous member of the public; via statutory agencies such as education; health and local authority social work or 3rd sector advocacy and support services. FGM may also be identified incidentally as part of unrelated duties such as responding to other concerns or when conducting investigations into other crimes or offences.

Children

Initial action in responding to girls at risk of FGM including an unborn child

Details of any disclosure made to a first contact police officer or member of police staff should be carefully noted in the officer’s personal notebook or other recording system i.e. STORM incident as soon as practicable. Such a disclosure and any initial interaction with a child should be regarded quite differently from a Joint Investigative Interview. In such circumstances the child should be allowed to provide any voluntary account or information, but, should not be ‘interviewed’ or questioned in detail about the commission of, or planned commission of FGM as this may undermine the reliability or admissibility of any information in a subsequent interview. The primary consideration must be the immediate safety of the child.

The Prohibition of Female Genital Mutilation (Scotland) Act 2005 makes it illegal to perform or arrange to have FGM carried out in Scotland or abroad. A sentence of 14 years imprisonment can be imposed which highlights the gravity of the offence. FGM should always be seen as a cause of significant harm. As such, when there is information to suggest that a girl has been, is or is likely to be subject of FGM and may be at risk of significant harm, all officers or members of police staff must immediately signpost to their supervisor and Divisional Public Protection Unit, or if outwith hours, the duty senior CID officer/Duty Inspector, who will be responsible for assessing the level of risk to the child or any other children. This should not be interpreted to mean a child protection joint investigation will commence on every occasion. It will ensure that our interface with partner agencies will reflect common standards of practice, and a shared language and understanding. It will provide a sensitive, proportionate response by specialist officers who are fully conversant with Police Scotland’s Child Protection - FGM Standard Operating Procedure, national guidance and local interagency child protection procedures to enable such procedures to be considered and implemented if necessary.

On all occasions information and intelligence databases must be researched in relation to the child and their family background. The minimum checks to be carried out by Police Scotland are:

• Police National Computer ( PNC).
• Police National Database ( PND).
• Criminal History System ( CHS).
• Scottish Intelligence Database ( SID).
• Violent and Sexual Offenders Register ( ViSOR).
• Command and Control system.
• Crime Management system.
• Vulnerable Persons Database.

Local inter-agency Child Protection procedures must be invoked for any child who has been subjected to FGM or where there is information that other risk factors are present.

On occasions where there is insufficient information to determine whether child protection procedures should be invoked, and more information is required to inform decision-making, the Divisional PPU or on duty senior CID officer should make an information sharing request to core partners (Social Work, Health and if appropriate Education) to share relevant information in relation to the child or any other child. This may result in an action for the most appropriate partner to engage with the child and her family in an attempt to gain further information. While PPU officers should be in a position to speak with parents/carers about the law and health implications and work collaboratively, the decision about which professional is best place to engage with a child and their family about FGM needs to be carefully considered and should be agreed (and documented) between agencies.

The outcome of family engagement must be shared with Social Work, Health and Police Scotland. If necessary child protection procedures will be instigated. Decisions around investigation i.e. joint or single agency, joint investigative interview and type of medical examination will be made by Social Work and Police in consultation with Health during any subsequent IRD.

Imminent risk of significant harm

In most cases where there are concerns about FGM, these are not associated with imminent risk. However, if a child is about to leave the country; there is information about a fleeing family; clear intent for FGM to be carried out within the UK or any other abusive or negligent behaviour which places a child or unborn baby at immediate risk of significant harm, the Duty Inspector must ensure that effective protection measures are put in place immediately and primary investigation commences in liaison with the Divisional PPU or duty senior CID Officer. Child Protection Procedures will be immediately instigated, during which time consideration will be given to the application for a Child Protection Order or other relevant protection order.

On occasions where the risk is such that it is not practicable for a CPO or other relevant order to be applied for, Section 56 of the Children’s Hearing (Scotland) Act 2011 provides for emergency measures, specifically a constable’s power to remove a child to a place of safety. Section 59 of the Children’s Hearing (Scotland) Act 2011 relates to the obstruction offence.

A child may not be kept in a place of safety under this section for a period of more than 24 hours. Therefore, as soon as practicable after a child is removed under this section, the Principal Reporter must be informed. In addition, officers must inform their supervisor and Divisional PPU or on duty senior CID officer immediately powers under Section 59 of the Children’s Hearing (Scotland) Act 2011 have been used to instigate child protection procedures.

Adult victims of FGM or adults at risk of FGM

The overarching principles outlined above apply to adult victims of FGM or adults at risk of becoming the victim of FGM. First responding officers or members of police staff must immediately signpost to their supervisor and Divisional Public Protection Unit, or if outwith hours, the duty senior CID officer, who will be responsible for assessing the level of risk to the adult. This will ensure a sensitive, proportionate response by specialist officers. While FGM is usually not undertaken for the sexual gratification of another, the circumstances of the act are such that when the victim or potential victim is an adult a Sexual Offences Liaison Officer will be deployed for the purposes of interview and act as a single point of contact.

Support from survivor advocacy services should always be considered prior to any interview taking place.

Officers must consider whether the adult victim or potential victim may have additional needs, such as interpretation services; an appropriate adult if any mental disorder is suspected or if the adult may be an adult at risk as per the Adult Support and Protection (Scotland) Act 2007. Any such concerns must be immediately highlighted to the Divisional PPU so that all necessary support can be provided or Adult Support and Protection Procedures instigated.

As above, the primary consideration must be the safety of the victim or potential victim.

Factors to consider

During an investigation into FGM it will be important to establish the timing of the victim and individual family members’ entry and exit of the UK, and secure passports; other travel documentation or payment receipts etc. which may be of particular evidential value.

All female members of the household and female relatives of the index case must be considered as being at risk of FGM and included in any risk assessment and safety planning.

For children, families and communities affected by FGM their previous experience of ‘authority’ figures, including the police, whether abroad or within the UK and Scotland may have been negative or traumatic e.g. asylum seeking communities. This may add barriers to collaborative and meaningful communication in addition to what is a sensitive subject.

If appropriate, a request may be made for an appropriately trained medical professional to conduct a medical examination. It may be in the child’s or woman’s best interest to have a medical examination for health and wellbeing purposes, without the need for forensic corroborative evidence a crime has not been committed within a country where unlawful. e.g. the FGM was carried out prior to entry into the UK. In all cases involving children, an experienced paediatrician should be involved in decision-making and arranging medical examinations.

When a criminal investigation is raised, the interviewing of children and young people must be undertaken in line with the Scottish Government Guidance on the Joint Investigative Interviewing of Child Witnesses in Scotland 2011, in order to obtain best evidence.

If any legal action is being considered, early consultation with the Crown Office and Procurator Fiscal Service ( COPFS) is important.

Police procedures

On all occasions a restricted VPD Concern Form and SID should be submitted at the point of reporting/referral updated as necessary and, on all occasions, at the conclusion of any investigation. To ensure the integrity and safety of those involved any STORM incident will also be restricted.

A crime report must be raised as soon as there is information that a crime has taken place in line with the Scottish Crime Recording Standards.

Officers should refer to the following documents on the force intranet:

• Child Protection Standard Operating Procedures ( SOP).
• Honour Based Violence, Forced Marriage and Female Genital Mutilation SOP.
• Scottish Government Guidance on the Joint Investigative Interviewing of Child Witnesses in Scotland (2011) .
• National Guidance for Child Protection in Scotland (2014) .
• Adult Support and Protection SOP.
• Appropriate Adults SOP.
• Interpreting and Translating Services SOP.

Note: the Victim and Witnesses (Scotland) Act 2014 provides for victims of specific crimes to specify a gender preference in relation to an interviewing officer and to gender preference for medical examiner. This does not specifically include FGM, but would be considered best practice.

3. Education: guidelines for teachers and other education staff

The Children and Young People (Scotland) Act 2014 (2014 Act) and the Getting It Right for Every Child approach require practitioners in all services for children and adults to meet children and young people’s wellbeing needs, working together if necessary to ensure children and young people reach their full potential.

Education is a universal service. Children and young people spend up to six hours a day in the care of schools and early learning and childcare centres. These services build up strong relationships with children, young people and their parents by creating a positive ethos and culture based on mutual respect and trust.

Children and young people may feel safe at school, and that they can trust education staff. So they may be more likely to confide in them.

Education services can also monitor attendance and physical health. They may notice children and young people at risk (for more on risk see section 5).

The National Guidance for Child Protection in Scotland (2014) states that FGM should always be seen as a cause of significant harm and local authority child protection procedures should be invoked. Education staff should work closely with other agencies. The welfare of the child/young person is always the primary concern.

Education staff can ensure a co-ordinated response in accordance with local guidelines on FGM. As with all child protection matters, staff should involve parents/carers unless the latter are the source of risk or harm.

Independent schools will already have child protection procedures in place. The response to suspected FGM should be the same as in a local authority school, that is, that child protection procedures should be followed.

If FGM is suspected, staff should follow child protection procedures and FGM guidelines without delay.

Education staff should know the risk factors and indicators of FGM (see section 5), including children going on extended holidays to areas where FGM is practised and behaviour change on return.

If there are other child protection concerns, these should be part of the risk assessment process. These may include factors such as trafficking or forced marriage.

Schools and early learning and childcare centres should include information on FGM within their annual child protection update. There is more information on the Education Scotland website at: www.education.gov.scot

Education staff should raise awareness of FGM and its legal implications with children and young people. For example, health and wellbeing (personal, social, health education) and RME courses could inform children and young people about FGM and its dangers. Education staff should also support children and young people to recognise and realise their rights within the United Nations Convention on the Rights of the Child.

Within Curriculum for Excellence, children and young people are entitled to personal support to enable them to:

• Review their learning and plan for next steps.
• Gain access to learning activities which will meet their needs.
• Plan for opportunities for personal achievement.
• Prepare for changes and choices and be supported through changes and choices.

This is particularly significant for children and young people who have been affected by FGM. All children and young people should have frequent and regular opportunities to discuss their learning with an adult who knows them well and can act as a mentor, helping them to set appropriate goals for the next stages in learning. It is essential that support is provided to remove barriers that may have been caused by FGM or other issues that might restrict their access to the curriculum because of their circumstances, or short or longer term needs.

School nurses

School nurses are in a good position to reinforce information about the health consequences of, and the law about FGM. They can also provide curriculum support.

School nurses, like teachers, may be in a position of trust. Girls/young women (or their friends) may confide in them.

School nurses should be vigilant for health issues in children such as recurrent urinary tract infection which may indicate that FGM has been performed.

If a school nurse has any contact with a family which comes from a country where FGM is practised, they should discuss the risks of FGM; and record the parent’s response, the outcome of the discussion, and the leaflets or advice they gave to the parent.

If a school nurse is concerned about a parent’s attitude towards FGM, they should take this concern seriously and discuss with a relevant senior colleague and local child protection adviser to consider an IRD.

Colleges and universities

If students are under 18, further educational establishments should follow their existing child protection policies when there is concern about a potential risk of FGM or if a student discloses that she has undergone FGM.

Universities are less likely to encounter girls at risk of FGM but they may become aware that a student is concerned about a younger female relative, for example, or who discloses that she has undergone this herself when younger. They should consider how best to respond in such circumstances, seeking the guidance of appropriate agencies.

4. Children and families social work: guidelines for social work staff

Children and families social work should investigate, initially, under Section 60 of the Children’s Hearings (Scotland) Act 2011.

Local authorities have a duty to promote, support and safeguard the wellbeing of all children in need in their area, and, insofar as is consistent with that duty, to promote the upbringing of children by their families by providing a range and level of services appropriate to children’s wellbeing needs.

When the local authority receives information which suggests a child may be in need of compulsory measures of supervision, social work services will make enquiries and give the Children’s Reporter any information they have about the child. The role of the registered social worker in statutory interventions: guidance for local authorities (2010) ^[33] stipulates that, if children are in need of protection and/or in danger of serious exploitation or significant harm, a registered social worker will be accountable for:

• Carrying out enquiries and making recommendations where necessary as to whether or not the child or young person should be the subject of compulsory protection measures.
• Implementing the social work component of a risk management plan and taking appropriate action where there is concern that the Child’s Plan is not being actioned and
• Making recommendations to a children’s hearing or court as to whether the child should be accommodated away from home.

Children and family social workers also either directly provide, or facilitate access to, a wide range of services to support vulnerable children and families; increase parents’ competence and confidence; improve children’s day-to-day experiences; and help them recover from the impact of abuse and neglect. For children in need of care and protection, social workers usually act as Lead Professional, co-ordinating services and support as agreed in the Child’s Plan.

In fulfilling local authorities’ responsibilities to children in need of protection, social work services have various important roles. These include co-ordinating multiagency risk assessments, arranging child protection case conferences, maintaining the Child Protection Register and supervising children on behalf of the Children’s Hearing.

Social work response to FGM

Staff should take all notifications of concerns about children seriously. Practitioners responding to these concerns should be aware that even apparently low-level concerns about FGM may point to more serious and significant harm. Practitioners should consider all cases with an open mind and not make any assumptions about whether FGM has, has not, or is likely to occur. Practitioners need to be alert to the possibility of FGM both for girls they already know, and also in cases in which concerns about girls are not stated at the outset, including other female relatives.

Practitioners should acknowledge all concerns, including those that do not require an immediate response, quickly, and indicate when a measured and proportionate response will be made. Practitioners should, in all cases, discuss and record all action taken.

Practitioners should carefully consider including and communicating with the child or young person and their parents; use of an interpreter; which professional should undertake this task and how best to do undertake it. Practitioners should find out if the parents or child have had information about FGM, its harmful effects and the law in Scotland. If not, practitioners should give this to the parents and, if suitable, the child.

Before staff decide whether a child protection investigation is required, it is essential that all relevant services are involved in an IRD. It is critical that information-gathering involves all other key services, including education, health, police, third sector and adult services. Staff should check agency records, any previous agency involvement or any known relevant medical history, including that relating to parents/carers.

Practitioners should consult with the social work lead for FGM.

Staff should then decide whether to progress concerns under child protection procedures. They should also consider how a girl’s wellbeing needs can be met, and whether a Child’s Plan is required.

If a girl is at immediate risk of harm

If a child protection response is required, staff should initiate an IRD. This may be face-to-face.

Practitioners must always balance the need to gather information against the need to take any immediate protective action. At this stage, information gathered may only be enough to inform an initial assessment of the risk to the girl(s). On the basis of the assessment of risk, social work, health and police need to decide whether to take any immediate action to protect the child and any others in the family or wider community. If the IRD decides that the girl is in immediate danger of FGM, and parents cannot satisfactorily guarantee that they will not proceed with it, then practitioners should seek a Child Protection Order (or other agreed emergency measures).

Practitioners should try to work with parents on a voluntary basis to prevent harm to any girl. The investigation must consider every possible way of achieving parental co-operation. If there is no agreement with parents, the priority is to protect the girl. The primary focus is to prevent the girl undergoing any form of FGM, rather than removing her from the family.

If necessary, staff should consider referring the child to the Reporter to the Children’s Hearing, convening a child protection case conference or whether emergency measures are needed.

If a girl has already undergone FGM

If a child has already undergone FGM, there must be an IRD to consider how, where and when the procedure took place and the implications of this.

The IRD needs to decide whether to continue enquiries or assess the need for support services. If considering legal action, practitioners must seek legal advice from local authority solicitors.

A child protection case conference is not usually needed for a girl who has already undergone FGM, nor her name listed on the Child Protection Register unless she is still at risk of significant harm or neglect. However, practitioners should offer counselling and medical help suitable for the girl’s age.

A child protection case conference is only necessary if there are unresolved child protection issues after the initial investigation and assessment are complete.

Practitioners should also consider the needs of any other girls at risk in the wider family.

5. Third sector organisations: guidelines for staff

Third sector organisations provide many services for children and young people. This includes nurseries, residential care, pre-school play groups, parenting and family support, youth work and other youth services, befriending, counselling, respite care, foster care, adoption, through-care and after-care, advocacy, helplines and education.

Public bodies, such as local authorities, may commission third sector organisations to provide direct services. If a third sector organisation is under contract to a public body, and providing a service on its behalf, it is under the duty of the public body.

Many third sector organisations have direct and indirect contact with children, young people and parents, even if this is not their principal activity. Providers of services to adults, for example for housing/tenancy support, mental health, disability, drug and alcohol problems, may become concerned about girls in a family, without having seen them. Anyone who is concerned about a child or young person’s wellbeing should share that information with the appropriate service. If there are concerns that a girl may be at risk of significant harm, they should share that information in accordance with child protection procedures, and National Guidance for Child Protection in Scotland (2014) ^[34] .

If a staff member (whether paid or voluntary) is working with a family, they should consider raising FGM when talking about, for example, life in Scotland, health, parenting or child protection. Staff should not assume that the individual, a family or community is affected by, or supports the practice of, FGM.

Identifying and responding to risk

If a staff member is concerned that a girl could be at risk, because of the indicators, they should talk to the family/parent about the risks and where to get help/support. They should give them information about the law in Scotland. If the family is intending to visit family/friends they could give them the Scottish Government leaflet ‘A statement opposing female genital mutilation’ ^[35] .

Staff should consult their supervisor/manager.

Staff should assess immediate risk to the child. If they identify immediate or serious risk, they should follow their organisation’s child protection procedures and refer to social work or police.

If there is no immediate risk, but there are potential risk indicators, the staff member should discuss, with the family, how to protect the girl. This includes whether family/parent(s) need ongoing support to protect the girl and any other girls in the family. Staff should record their actions. If there are several risk factors it may be more appropriate to instigate child protection procedures.

If a girl has already undergone FGM

Staff should instigate child protection procedures immediately.