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1.6.3 Guidance for Joint Working with Children and Families with HIV/ AIDS

Contents

  1. Introduction
  2. The Team
  3. HIV Child and Family Social Work
  4. Confidentiality Statement
  5. Case Examples
  6. Recording
  7. Referral Process Flowchart


1. Introduction

This post was established in July 2003 and funded as an Adult Services secondment opportunity. In the first eighteen months it was evidenced through literature research and direct work with service users and families that not only was there a demand for this work but that this was growing. Agreement was reached with Children Services to fund the secondment further, and in May 2006 it became a substantive post responsible to Children Services.

As a specialist HIV and Sexual Health Team worker we come into contact with some of the most vulnerable families who experience a magnitude of disadvantage and discrimination e.g. poverty; racial harassment; prejudice and unsafe immigration status, alongside the obvious health issues. Often these families do not come to the attention of other services as families are fearful of people finding out about their diagnosis, thus isolating them from community supports.

Some families may be isolated from the support and help of relatives and friends because they are unwilling to tell others about their HIV status, or because those who have been told have reacted with hostility. The circumstances surrounding the infection of family members may cause family conflict, and individuals may be experiencing denial, guilt, blame and/ or rejection.

It has to be asked, why is an HIV diagnosis so different to any other long term health condition? The reality is that a moral judgment is made of those infected. HIV is a blood borne virus that can also be present in bodily fluids. Transmission can occur between mother and child at birth or by breastfeeding; by receiving contaminated blood products; sharing needles but more commonly HIV is a sexually transmitted infection. For some this raises questions of a person's perceived behaviours. There is an unfounded fear of 'catching' the virus. Stigma and prejudice surrounds those infected and affected.

There is an identified need to support families living with HIV. However, the development and deployment of staff with the appropriate skills to provide this service can be complex. Many of those working primarily with children and families may have limited knowledge of issues relating to HIV, whilst those more skilled in HIV work, may lack detailed knowledge of children's issues, procedures and practices. The benefit in providing a smaller group of staff with more specialist training to work with families living with HIV is evident and delivered in Newcastle Social Care Services by the HIV Social Work Team that includes adult and children services staff. There will be an overlap of work the aim of these procedures therefore to define roles and responsibilities.


2. The Team

The HIV and Sexual Health Team is based at the Royal Victoria Infirmary.


3. HIV Child and Family Social Work

If a child, who has a positive diagnosis, is known to Children's Social Care, the HIV Child and Family Social Worker is the social worker for the child and family in relation to testing for, disclosure of and support around HIV / Aids. The HIV Child and Family Social Worker works along side the allocated social worker for the child.

If involvement relates to pregnancy, HIV Child and Family Social Worker involvement will also focus on ante-natal care and treatment and work around transmission and/ or disclosure.

The HIV Child and Family Social Worker also works with families where there is no active Children Social Care involvement, to support parents, children and wider family members with issues of testing for, disclosure of and support around HIV/Aids.


4. Confidentiality Statement

Any adult or child with an HIV diagnosis has a right to complete confidentiality in relation to their diagnosis.

Adults can consent to their diagnosis being disclosed. This must be explicit consent and clearly recorded. Adults can consent to their child's diagnosis being disclosed. However, in line with Fraser guidelines children have the right to consent or not to their own disclosure, including to their parents.

Children and parents' involvement in the Child Protection arena does not over-rule this right to confidentiality.

Professionals within Child Protection can over-rule confidentiality only when an HIV diagnosis is a clear Child Protection concern.


5. Case Examples

Example One:

Mother and father were involved with Children's Social Care due to father's lifestyle and offending. Both parents had positive diagnosis and were compliant with medication and mother was pregnant. In this situation, their HIV diagnosis was not disclosed within Child Protection arena.

Example Two:

Mother has a positive diagnosis and was pregnant. She was not attending clinic in relation to her diagnosis, and was not taking her medication. Mother had not disclosed her diagnosis to her partner who was father to the unborn. Concern was that mother would not ensure baby received medication and that father could not safeguard the baby as he was unaware of mother's diagnosis. In this situation, mother's diagnosis was disclosed.

Talking to or communicating about a person's HIV diagnosis is disclosure. Therefore, in professional meetings or communication, a person's HIV diagnosis cannot be discussed unless HIV is the over-riding Child Protection concern (see examples above), or a person has given their explicit consent for every person in that meeting to know their diagnosis.

It is best practice to consult and inform a person in relation to disclosure of their diagnosis when case responsibility transfers between workers within the same agency, for example upon transfer from Initial Response Service to Assessment and Monitoring, or midwife to health visitor.

When other professionals become involved with a family it should be considered on an individual basis if that professional needs to know a person's diagnosis. In most cases, not all professionals involved with the family need to know a person's diagnosis.

It there are any doubts about disclosure there should be consultation with Carolyn Brunton (2824732) and Legal Services.


6. Recording

When completing recording on a child's file where a family member has a positive diagnosis this diagnosis should only be referred to as 'chronic illness'.

This is how information should be recorded in most cases. The exception to this would be where a person's diagnosis is the over-riding Child Protection concern and not to record the diagnosis as HIV would place the child at risk.


7. Referral Process Flowchart

Click here to view the Referral Process Flowchart.

End