HWKKS Sabah

September 2026

SCAN

Suspected Child Abuse and Neglect

OUTLINES

• Introduction to SCAN team
• Role of SCAN team
• Preventing missed abuse cases

SCAN TEAM REFERRAL 2025

Total cases: 457 referrals

Level A Hospitals �(State Hospitals)

• Headed by Paediatrician
• A medical social worker responsible for the paediatric department
• JKM officer (Child Protector)
• Police Officer (Inspector or higher rank)
• Specialist(s) from the Paediatric Department, Emergency Department, O&G, Psychiatry and Forensic department
• Paediatric and/or OSCC nurse (Sister)
• Counsellor, psychologist, if available
• Additional members may be added to the team as appropriate (e.g. Deputy Public Prosecutor, Hospital/School counsellors)

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Level B Hospitals �(Other hospitals with specialists)

• Headed by Pediatrician
• Specialists / Medical Officer from O&G, Emergency Department, Psychiatric, Forensic Department
• Medical social worker
• JKM officer (Child Protector)
• Police Officer
• Nurse, preferably Sister of the Pediatric ward or equivalent in authority and/or experience.

Level C Hospitals �(Hospitals without specialists)

• Headed by the Family Medicine Specialist /Hospital Director
• Senior nurses / Medical Assistants
• JKM officer (Child Protector) should also be a member, wherever possible, and/or a police officer (preferably the same members of the District Child Protection Team)

ROLE OF SCAN TEAM

• To serve as a multi-disciplinary referral team within the hospital
• To assess the likelihood of abuse or neglect for referred cases
• To provide coordination amongst the various agencies in case evaluation, management and reporting of child abuse cases
• To develop and review hospital policies and procedures for the handling of suspected or actual cases of child abuse and/or neglect
• To provide and organize echo training for the state
• To maintain a database on the cases handled by the team
• To enhance community awareness on the prevention and reporting of SCAN cases

PREVENTING MISSED ABUSE CASES�What to watch for and how to act?

WHY ABUSE IS MISSED?

IMPORTANT QUESTIONS TO ASK

PHYSICAL FINDINGS

Bucket handle fracture

Corner fracture

HOW TO ACT?

MEDICAL ASSESSMENT

• All cases of suspected child abuse should be referred to Pediatric team-on-call.
• The medical officer should inform specialist-on-call
• History and conduct physical examination
• To assess the mental and developmental functioning of the child
• To assess the needs of the child and the capacity of parents to meet the child’s needs
• Recognise children (whether abused or not) in need of support and/or safeguarding, and those parents who may need extra help in bringing up their children

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WHEN TO ADMIT?

• Where safety is a concern (as in intra-familial abuse or other concerns about physical safety or neglect or lack of supervision)
• ALL CASES OF CHILD SEXUAL ABUSE :
• for medical management of acute physical and emotional trauma
• for examination by experienced medical staff and when the child is more settled (especially “chronic” cases)
• to obtain further information from the child survivor
• to rule out possible incest
• for post-traumatic stress counselling of child and family
• for counselling of social and legal ramifications following the abuse
• to determine the most suitable placement for the child
• Presentation after office hours to enable review by the SCAN Team and to ensure a satisfactory initial assessment and safe placement of child

DOCUMENTATION

• Timing of examination
• Examination findings and circumstances involved
• Photography and video-colposcopy of abnormal physical and genital examination (with written consent)
• Forensic specimens sent should be correctly and completely labelled
• Fill in the preliminary medical report form issued by the police officer for sexual abuse cases or give a medical report as soon as possible to the police officer
• Police report number, police officer-in-charge and JKM officer-in-charge of the patient should be noted
• Should the police or JKM wish to bring the child out of the ward, there should be an official letter from the department requesting permission. The name of the police officer, police identification number or name of JKM officer and office branch should be documented in patient’s notes.

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CONSENT FOR EXAMINATION

• Consent from parent or guardian
• By police officer with a written order for examination (Borang Pol59)
• If ordered to by a Child Protector (Gazetted JKM Officer)
• Clinical Examination e.g. for pain in the genitalia or on passing urine, parental consent is implied as in part of a full physical examination for medical illness.
• Police reports are not required per se in this instance where the child has not given a history of sexual abuse.
• Parent(s) should be around during the time of examination (and this is documented)
• Doctors should lodge a police report themselves after the examination IF there is a strong suspicion of sexual abuse and the parent or guardian remains reluctant to lodge a police report.
• Consent / cooperation from child vs EUA

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JKM NOTIFICATION

• Doctors are mandated by law to report to JKM (Borang 9 / Borang Kebajikan)
• This should be accompanied by a report giving reasons for suspicion or diagnosis of child abuse
• This may be followed up subsequently by a more comprehensive medical report in complicated cases
• Determine JKM office responsible (from address of child)
• Fax JKM Borang 9 and preliminary medical report by Medical Officer to JKM office followed by phone call by the Medical Social worker/ ward staff
• Key worker in SCAN team coordinates management and notification

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POLICE REPORT

• For all sexual abuse cases
• For severe or chronic physical abuse
• In children with severe neglect
• Urgently in life-threatening situations or if other children are at immediate risk
• Where there is a risk for future substantial harm to the child or other children under the care of the alleged perpetrator
• Decision to make a police report should be made in consultation with senior staff.

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MEDICAL REPORT

• Complete relevant medical examination. Avoid medical jargon.
• Include relevant negative findings as well as positive physical examination findings.
• To include any adverse emotional or psychological impact on the child and, if relevant, disability consequent to the abuse
• Record and document all positive and relevant negative physical findings well
• Record time and date patient seen and examined
• Standardized recording format should be available at each hospital
• Diagrams are useful
• Photography (with name, RN, date and time taken & photographer’s name) – for physical or sexual abuse cases usually kept as a reference for the doctor rather than to be submitted to police
• Names of all staff involved to be written legibly or name chop used

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MEDICAL REPORT

• Do not write detailed history as given by patient but rather the reason for examination e.g. alleged sexual abuse
• Do not write “no evidence of sexual abuse” where examination findings are normal as the history given by the child may be strongly suggestive of sexual abuse.
• No evident injury may be present at the time of examination but physical evaluation alone cannot exclude sexual abuse
• To include a report from psychiatrist if deemed useful as in custody cases

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CHILD PROTECTION MANAGEMENT �AND DISCHARGE CHECKLIST

• Check immediate safety
• Document concerns
• Consult with specialist on call/ SCAN Team member
• Support by a person of same race or religion or a concerned person, if no supportive guardian available
• Inform family and/or child/young person of concerns. Discuss likely process with child/young person/family
• Notify Jabatan Kebajikan Masyarakat (using Borang 9 and give preliminary report)

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• If police report to be made, ask parent/guardian to make police report
• Police report must be done urgently for all cases of sexual abuse less than 72 hours after the alleged incident and for selected cases of physical abuse or neglect especially where the child’s life/ safety is at risk.
• Doctor should be the one to lodge the police report if the parent is not immediately available or uncooperative or where intra-familial abuse suspected
• Arrange medical assessment with specialist unit/doctor (e.g. gynaecology, orthopedic, ophthalmological, neurosurgical units)
• Consent from parent/guardian if patient under 18 years of age or with legal authority (police/JKM officer), as required
• Arrange non-urgent medical appointment & investigations (sexually transmitted infections (STI) screen, skeletal survey)
• Psycho-social assessment

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• Follow-up arranged. Inform family of arrangements (after consultation with SCAN Team/ social worker)
• Identify key worker (medical social worker/paediatrician/psychiatrist/ gynecologist)
• Reply to referring doctor, if any (by ward medical officer/paediatrician)
• Complete medical report in patient’s case notes (by doctors from relevant medical discipline)
• Complete SCAN patient record forms
• Check correct name and address details
• Obtain alternative contact address
• Confirmation of discharge by SCAN team key worker & ward doctor.
• Letter from JKM may be required in cases where safety of child post discharge is an issue
• Inform police of discharge if a police report has been made
• Send patient BHT to OSCC to photostat a copy of relevant documents
• Add to database

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TAKE HOME MESSAGE

THANK YOU