A Conference on Joint Working in Hampshire

A Conference on Joint Working in

Hampshire

Housekeeping

•Alarms

•Toilets

•Smoking

•Breaks

•Register

Learning OutcomesPromote the use of the three revised 4LSCB protocols Raise understanding of how to use the protocolsExplore challenges to implementationConsider changes in practice

Agenda

0945 - Keynote address

1000 – Introduction to the protocols

1045 - Tea/coffee

1115 - Case study exercise

1230 - Plenary session

1300 – Close

Next Steps

•Raise awareness within your organisation.

•Promote and ensure use in practice and supervision.

•Auditing of use and compliance.

END

•Presentations will be sent out.

•Please complete the survey monkey evaluation.

Have a safe journey home!

HSCB Conference: Joint Working in Hampshire

Andrea O’ConnellDirector of Quality: West Hampshire Clinical

Commissioning Group

Aim of today• Promote the launch of the 3 multi- agency protocols• Raise your understanding of the key changes within

the documents• Give you an opportunity to use the protocols• Consider changes in practice• Explore some of the challenges to their

implementation

‘Everyone who comes into contact with children and families has a role to play’(Working

Together 2013)

• The protocols have been developed and revised as a direct result of learning from recent local serious case and multi agency reviews

Application in practice will:• protect children• support Practitioners in the early identification of abuse and

neglect• Support the early help agenda

Expectations of you• Consider how you will cascade the protocols

within your organisation• Ensure that key changes are understood

amongst your staff• Ensure that the protocols are consistently

applied to practice• Monitor the use of the protocols

Conclusion• These protocols are not new, they have been

in place for sometime, however their use has not always been applied to practice

• This has made children more vulnerable• In future we need to ensure the protocols are

understood and used- across agencies to effectively safeguard and protect children

Andover War Memorial Hospital Basingstoke and North Hampshire Hospital Royal Hampshire County Hospital

Joint Working ProtocolUpdate February 2014

Sheila Hodgkinson and Helen Hudson

Safeguarding Children Team

Hampshire Hospitals Foundation Trust


Background• A protocol to provide a robust framework for responding to

safeguarding concerns for unborn babies and neonates within Hampshire and the Isle of Wight

• To enable practitioners to work together with families to safeguard unborn babies where risk is identified (section4-risks)

• The antenatal period gives a unique window of opportunity for practitioners and families to work together

• Applies to any practitioner working within health and children’s services

• Make plans


What's New?• More emphasis on using Early Support

• If CAF or TAC (Early Support Hub) is used and there is a high level of concern – consider inviting CSD to the meeting

• Review regularly (and document) reasons for not making a referral or completing an assessment to consider risks and if any further action needed.


What's New?

• Remember CAF/Early Support is not required where it is identified that the UBB has already met the threshold of being at risk of significant harm

• The optimum time for ICPC is between 28-32 weeks


Planning

• Safeguarding birth plan to be developed by 34 week – including any agreed decision for a home birth (see checklist)

• CSD are to ensure that ‘Out of Hours’ are made aware of safety planning


Planning

• It is recognised that hospitals are not secure settings or a place of safety so supervision may need to be put in place by CSD

• If extended hospital stays are required for social reasons only this needs to be risk assessed individually and hospitals may charge the LA in these situations

• Police protection units must be informed of the safeguarding birth plan if Police Protection is going to be considered.


On going challenges

- Impact on baby attachments

Mental capacity issues during labour and agreeing section 20

-Partners who are RSO’s

-Perinatal mental health service for 16-17 year olds

- Impact on other families in maternity


In conclusion – main changes

• Consider Early Help

• Information sharing

• Planning in pregnancy weeks, no one told the baby their due date.

• Any questions

Safeguarding children whose parents/carers have problems with mental health,

substance misuse, learning disability and emotional/psychological distress

• First written in 1999• Hampshire, IOW, Portsmouth & Southampton• Purpose• Early help before safeguarding becomes an issue• Multi-agency• Still not widely known and used• Need organisations and staff to own it



Key messages

•Separate key messages & flowchart

•Awareness of children and adults in the household

•Information can and should be shared

•Eligibility criteria does not trump safeguarding

•Risk increases when more than one problem exists

•Be persistent



Key messages

•People want help to parent their children well

•Don’t let anyone be invisible

•Work with strengths

•Follow your instincts and seek support/advice

•Family centred approach

•Work together

4LSCB bruising protocol2013 revision

Jean PriceFebruary 2014

Case example

A young child a few months of age presented to a GP

Child was unwell (miserable, Grizzly, off food)

Doctor noticed she had small bruises to her face.

Case example

Doctor treated her for slight infection, and agreed to follow up 3 days later.

Child was on life support and died

Case example background

Mother had a difficult pregnancy and Birth

Mother felt the child was difficult to feed and care for and mother was depressed

Child not bonding to either parent

Case example

Post Mortem - subdural haemorrhage facial and body bruising 3 fractured ribs

Case example - SCR

Independent author of SCR criticised the Bruising protocol stating it was not clear – who to refer to when a premobile child presented with bruising

Recommended – Revision of protocol Training

Bruising protocol

First developed 2010

Concerns re professionals not appreciating the possible seriousness of bruises(small) infants

Reflected in National SCR’s

Shaken babies

Serious Loss of

consciousness Coma Collapse Apnoea

(breathing difficulties)

Fits

Mild Poor feeding Irritability Lethargy Vomiting Isolated fit

Current position

4LSCB bruising protocol introduced 2010

Revision planned Jan 2011- delayed pending audit of current practice

Recent Hants SCR recommendation to have new protocol in place by 31st Jan 2014

Combined audit data Solent E&W

29 infants seen- 8 birthmarks- 5 accidental injury- 2 ‘other’ (1 no injury, 1

unexplained)- 14 investigated, fractures found in 3

Care proceedings in 7

Audit findings Solent W 2012/13 (1)

17 referrals of non-mobile <1’s accepted for examination, 16 seen by Solent W paed and 1 by UHS

5 birthmarks (of which 2 were fully investigated before diagnosis clear)

3 accidental explanations accepted 8 Likely inflicted injuries (7 bruising, 1

burn) - full investigations 1 unexplained, clotting studies only (UHS

case)

Audit findings Solent W 2012/13 (2)

8 infants investigated fully; fractures found in 2 (1 of whom had been seen previously with torn frenum and ear bruising)

- 2 cases closed after s47 enquiries, no case conference

- 1 case conference and child protection plan (mother admitted causing injury)

- 5 removed, care proceedings in progress

Why have a bruising protocol? 1

13/43 children admitted to a regional centre because of serious abusive injuries had a ‘harbinger injury’

11/13 harbinger injuries were bruises 8/13 harbinger injuries had been seen by

a health professional Only 1 child had been referred to

children’s services at the time of the initial injury

(Coupes and Smith 2006)

Revised protocol (1)

Remains a protocol

Applies to non-mobile infants up to age 2yr

Applies to all those whose work brings them into contact with children

Revised Protocol (2)

A seriously ill or injured infant should be referred to hospital immediately

Inform Social Care


If anyone notes a bruise: Record what is seen and any explanation

offered (body diagram if possible) Inform parents/carers that you are obliged

to follow the bruising protocol Refer to children’s social care (MASH) who

will take responsibility for further assessment including arrangements for a paediatric opinion within 24hr (ideally same day)


Specific considerations Birth injury- follow protocol if in doubt

about origin or features Birthmarks- may not be present at

birth. If unsure whether the mark is a bruise, discuss with primary care team in the first instance

Injury explained as self-inflicted or caused by a sibling- refer

Flow Chart for the Management of actual or suspected bruising in infants who are not independently mobile

Practitioner observes bruise

Suspect child maltreatment

Accurately record what is seen and explanation/comments by

parents/carers

Explain to the family the reason for an immediate referral to

children’s social care department

Refer to Children’s social care for multi agency assessment and

information sharing.

Same day paediatric assessment will be undertaken

An infant who is seriously ill or injured refer immediately to

hospital.

Notify children’s social care department

Follow 4LSCB procedures

Thank you

Jean PriceDesignated Doctor Southwest Hants CCG

A Conference on Joint Working in Hampshire

Documents

Transcript of A Conference on Joint Working in Hampshire