“Thinking the Unthinkable”. Housekeeping Alarms Toilets Smoking Breaks Register.
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Transcript of “Thinking the Unthinkable”. Housekeeping Alarms Toilets Smoking Breaks Register.
Aim
A conference organised by the Multi Agency Safeguarding Forum
North East designed to challenge professionals in some of their
thinking about abuse.
Learning Outcomes
1. Getting professionals to challenge their own thinking and avoid fixed thinking.2. To consider how to develop professional curiosity.3. To consider the need for appropriate challenge4. To explore learning from serious case reviews5. To raise awareness of joint working protocols
HSCB Priorities
• Embedding the HSCB Quality Assurance Framework
• Ensuring compliance with the new Statutory Safeguarding Guidance
• Safeguarding disabled children• Tackling child sexual exploitation• Young people who self harm
Programme0900 – Arrival and registration 0930 – Welcome and administration - Lin Ferguson, Chair of MASF0945 – Keynote speech – Professor Eileen Munro1045 – Break1115 - Joint Working Protocol - Bruising Protocol - Dr Simon Jones 1215 – Lunch1300 – Case study exercise – Inspector Darren Murphy and Alison Nealis, IRO 1430 – Break1500 – Multi Agency Safeguarding Hub – Sarah Marston, District Manager Childrens Services 1530 – Plenary session – Alison Nealis1545 – Close
End
• Presentations will be sent out.• Please complete the survey
monkey evaluation.
Have a safe journey home!
Outline You are human beings
Understanding how we use our intellect and emotions
Being critical
You work with human beings Importance of relationships Challenges
Importance of organisational context
Understanding how we use our intellect and our emotions
We have two processes for reasoning – intuitive and analytic
Emotions play an essential, valuable, but sometimes troublesome part
Intuition and analysis are on a continuum; we use both to varying degrees in different tasks.
Intuition has persistent biases that need to be consciously checked for by our analytic capacity.
The task determines the type of reasoning needed•The balance of intuitive and analytic reasoning needed depends on the task you are doing.
•Some need a mainly intuitive approach; some need a mainly analytic approach.
•Neither is ‘best’ is an absolute sense
Human reasoning
“System 2 [our analytic skill] is the supporting character who thinks she is the hero. The defining feature of system 2 is that its operations are effortful and one of its main characteristics is laziness. As a consequence, the thoughts and actions it thinks it has chosen are often guided by system 1 [intuition]”Kahenmann, D. (2011) Thinking, Fast and Slow, London, Allen Lane
Analytic thinking as a personal trainer•Intuitive reasoning is the basic process that we then improve by using analytic thinking to:
•articulate•check (being aware of biases)•test deliberately
Respectful uncertainty
Intellectually accurate but
Very uncomfortable
Workers need prompting and support to question their assessment –hard to do on own, however senior.
Being critical
Reluctance to change our minds
First impressions – anchoring
Using limited range of information
Attribution error
Hindsight error
De-biasing
•The common element in all strategies is to consider alternative perspectives:
– Thinking why your view might be wrong– Devil’s advocate deliberately taking
opposing view– Reducing attribution error by thinking
about how you might have behaved.
Supervision
•Where you help the worker articulate the reasons for their intuitive judgments
– Stories can be good mechanism
•Help them consider their emotional responses•Check for biases in their reasoning•Consider how else to test judgments•Consider relevant research
Articulating intuition: developing the story•Makes you think beyond the current snapshot: stories have a flow
•What happened? Need description
•Why did it happen? Need analysis
•What might happen? Devise plan to reduce chances of adverse and increase chances of good outcomes.
Dealing with dissent
Culture of good manners can stifle dissent at multi-agency conferences
Disagreement can feel like personal attack and so gets hostile response
Need culture that allows people to query judgments impersonally
Disagreements should be taken seriously and simple rejection not permitted.
You are working with human beings•You can deliver a pizza but you cannot deliver a child welfare service. You need the ‘customer’ to be an active agent in the production of the required outcomes. Child welfare services simply fail if the intended recipients are unwilling or unable to engage in a constructive way; outcomes are co-produced by citizens.
•Adapted from Chapman J. (2004) System failure: why governments must learn to think differently,
London, Demos
Features of the Working Alliance
Family:
Agrees with worker on the tasks to work on
Agrees on goals
Develops an affective bond
Challenges: emotionsChild maltreatment arouses strong feelings. We deal with families expressing strong emotions of anger, despair, fear.
Workers need support and critical reflective supervision in managing the emotions or they distort reasoning
Challenges: handling ambivalence•Families have strengths and dangers
•Holding both in mind as you work with them is difficult
•Focusing on good OR bad alone distorts understanding
Challenges: limited knowledge•We have limited understanding of all aspects of the work – causes, identification, responses
•In specific cases, we have limited knowledge of what is going on.
•We need to value and support expertise and professional judgment
We want to ensure that all children are safe but we can’t. There is too much uncertainty
Respecting this means that we stop talking of ‘ensuring’ all children are safe – aim to make them SAFER
Challenge anyone who believes managing risk = eliminating risk
Challenges: managing uncertainty
A just culture not a blame culture
Need to develop shared features of making decisions in uncertain conditions
Don’t set unrealistic goals of ‘ensuring’ all children are safe
When are rules desirable?
•Need central prescription of goals and professional duties•Simple tasks – follow the rules, e.g. arranging payment for foster carer•Complicated tasks – needs professional skill in deciding what the task is and how to perform it, e.g. does this referral warrant a S47 investigation? •Complex tasks – no complete solution is known but we seek to minimise the problem, e.g. preventing child maltreatment
Supporting the workforce
Closer involvement with families has an emotional dimension. Workers are exposed to the most intensely painful of human emotions - fear, despair, anger, sadness. Do they feel helped to handle this? If not, they are more likely to show the features of burnout: emotional exhaustion and compassion fatigue. Emotional resilience in workers is associated with feeling that they have a manageable workload and a sense of personal accomplishment.
Organisational factors that discourage good thinking
•A blame culture•Risk management through defensive practice•Very prescriptive procedures that discourage creativity and flexibility•Heavy caseload so little time to think•Culture that devalues need for critical review•No feedback on outcomes
Key points
We are all vulnerable to intuitive errors of reasoning: they are a feature of being human, not of being stupid.
We will make most progress if we think of good reasoning as a shared responsibility
Joint Working ProtocolConsider children of parents with
mental ill-healthsubstance misuselearning disabilityemotional or psychological distress
All Children (11 million)
280,150 children in Hampshire
Vulnerable Children (4 million)
Children in Need (400,000)
~ 10,000 children in Hampshire
Children Looked After (60,000)
1,266 children in Hampshire
Child Protection Plan (29,000)
1,113 children in HampshireThe Protection of Children in England A Progress Report, Laming, March 2009
Joint Working ProtocolConsider children of parents with
mental ill-healthsubstance misuselearning disabilityemotional or psychological distress
Early help – secondary prevention
Not at level of significant harm
Joint Working Protocol1999 following SCR2004 – ‘Hidden Harm’2008 – young people2011 – parents with LD2014
Joint Working ProtocolRecord
Child’s name, dob, address, carer, schoolAsk ? CSD / CPP / CAF / young carer
DiscussProfessionals involved, safeguarding lead
ReferCSD for early helpor Drug/alcohol, LD, mental health services
Joint Working ProtocolKey messages
Hear the ‘voice’ of the childDiscuss concerns with the familyKnow when to act immediatelyShare information & update with new
concerns eg non-complianceStay involved
Joint Working ProtocolSharing Information
Share with consent if appropriateSeek advice, consider safetyNecessary, proportionate, relevant,
accurate, timely, secure (Data Prot Act)Keep a recordDuty to share written into all legislation
GMC Guidance for Doctors
Importance of consent in most cases
Disclosure without consent justified if
Failure to disclose may expose patient or others to risk of serious harm
3rd parties who are of direct relevance to child protection eg adults who may
pose a risk to a child
Common law duty of confidencePersonal information should not generally be disclosed without consent of the subject
Disclosure without consent justified in the public interest to prevent harm to others
proportionate response
sanctioned by law (Art. 8 HRA)
go no further than necessary
Data Protection Act 1998Necessary, proportionate, relevant, accurate, timely, secure
Allows disclosure without consent
o Prevention or detection of crime
o Apprehension or prosecution of offenders
o Exercise of a statutory function eg s17/47
o Exercise or defend legal rights eg Art 3 (HRA)
Bruising ProtocolBruises in infants and toddlers - ‘those who don't cruise rarely bruise’Sugar NH, Taylor JA, Feldman KW. Arch Paediatr Adolesc Med 1999;153(3):399-403
Bruises are rare in babies not mobile
366 < 6 months only 2 had bruises (0.6%)
973 < 36 months none had bruises on hands or
buttocks
Bruising Protocol
o Raise awareness of significance of bruising in NIM (non independently mobile) children
o Reflect lessons learned from SCR
o Encourage sharing of concerns
o Consistent with NICE guidance
o Guard against professional optimism
o Joint Health & Social Care 4LSCB-wide policy
Bruising Protocol
20 days, bruise to right cheek ‘2y sibling threw a toy’
18 weeks, small bruise on forehead ‘hit with a teething ring’ by sibling
20 weeks, bruise under left eye seen by GP, no action taken
21 weeks, bruises on face and abdomen, seen by paediatrician, no action taken
26 weeks, fell out of chair, bruise to nose referred to CSD
Individual Management Review (IMR)
Health Practitioner observes bruise or suspicious mark SUSPECT child maltreatment1
A child who is seriously ill should be referred immediately to hospital
Seek an explanation, examine and record accurately Note any other features of abuse2 eg bruises on face and
‘soft’ areas, bruises in clusters or imprints
Explain to family the reason for immediate referral to Children’s Services Department
and Consultant Paediatrician3
Immediate Phone Referral to Children’s Services
Department for multi-agency assessment
and information sharing
Inform GP and HV
Immediate Phone Referral to Duty Consultant
Paediatrician3
and child seen urgently for further investigation to
exclude a medical condition
Inform GP and HV
Follow 4LSCB
Procedures4
Personal Reflections
“At no point during her stay in hospital, did any doctor speak to Victoria in a formal attempt to find out what had happened to her, either with or without the assistance of an interpreter... in the end she died a slow, lonely death – abandoned, unheard and unnoticed”
Lord Laming
Personal Reflections
“…these services knew little or nothing more about Victoria at the end of the process than they did when she was first referred…”
Lord Laming
Personal Reflections
Investing for the future
Culture of openness
Changes in practice
Keeping Children Safe
Think The Unthinkable• Working together guidance ‘makes
absolutely clear the legal framework and the expectations on different professionals’. This requires a major rethink in those agencies who still believe that their role in safeguarding stops with a referral to social care.
• the Government Guidance stresses two key principles:
• Safeguarding is everyone's responsibility, and • Where professionals are concerned each and
every agency has a role to play in safeguarding and protecting our children.
Think The Unthinkable• When it comes to “organisation culture” there is a
need to: • Create a culture of listening to children ensuring
there is senior buy in to safeguarding and ensure accountability of commissioned providers and contractors.
• Have a designated professional with sufficient time and support (including supervision) to promote the welfare of children. These professionals should recognise the needs of children including rescue from possible abuse and neglect.
• Follow safe recruiting practices. • Ensure all staff and volunteers are competent to
safeguard the welfare of children and that their practice is reviewed. There should be a mandatory induction and procedures about responding to concerns about a child’s welfare followed.
Think The Unthinkable• Here are the key messages from WTSC
2013 …Are these new messages? • Child-centred practice • Improving inter-agency working
relationships to support effective safeguarding practice
• More effective prevention and early help • Better Assessments • Strengthening accountabilities and
creating learning frameworks • Supporting the development of
professional’s expertise and effective social work practice.
Think The UnthinkablePROFESSIONAL COURAGE AND CURIOSITY
•The views and feelings of children are actually very difficult to ascertain. •Professionals do not always listen to adults who tried to speak on behalf of the child and who may have important Information to contribute. •Parents and carers can easily prevent professionals from seeing and listening to the child •Professionals can be easily fooled with stories we want to believe are true •Is it too difficult to explore thinking/develop and test hypotheses when parents are present in meetings? •Effective multi agency work does not just happen by accident. It needs to be co-ordinated. •Challenging parents (and colleagues) requires expertise, confidence, time and a considerable amount of emotional energy
Think The Unthinkable• Table exercises:• We would like you read the case study
on your table, complete the tasks requested.
• Please feedback your table’s 3 practice principles or “Golden Rules” to support practice which in turn can improve professional curiosity and professional courage.
• Hampshire Children’s Services Department have developed a Multi Agency Safeguarding Hub which operates alongside Hantsdirect and Children’s Reception Team.
• MASH became operational on 31/01/14
Referral Pathway to Children’s Social Care
Children’s Reception TeamEmbedded Social Work Team
Direct Professionals Line
PublicHantsdirect
Social Care
Signposted
R&A
• Children’s Services inclusive of education and YOT
• Police• Adult Social care• Health
Partners involved in MASH
Virtual Partners
• Probation
• Housing
• District Councils
• Hampshire Fire and Rescue Service
• Hampshire Ambulance Service
Adult Services
PoliceHealthChildren
Social Care& Education
CYP triageCA12
HampshireProbation Hampshire
Ambulance service
Borough and District
Councils
MASH
HampshireFire /
Rescue
Virtual
HousingCommunity
Safety
Troubled Families
Benefits of MASH• A faster, more co-ordinated and consistent
response to safeguarding concerns about vulnerable children and adults.
• An improved ‘journey’ for the child or adult with a greater emphasis on early intervention and better informed services provided at the right time.
• A more straightforward and responsive process for the professional or customer raising a concern
• Closer partnership working, clear accountability and improved multi-agency communications.
• A reduction in the number of inappropriate referrals and re-referrals leading to effective targeting of services
Benefits continued
• Avoids duplication and silo working.
• Staff and agencies have an increased understanding and appreciation of each others roles and responsibilities leading to increased skills, better multi agency working and more effective judgement.
• Development of flexible working patterns and providing enhanced customer service.
Workflow April – June 2014 Hampshire• 17743 contacts managed by CRT
• 5723 referrals through MASH
• 401 Section 47
• 2778 C&F Assessments
• 186 referrals stepped down to Early Help
Current Position• MASH service has been operational for 8 months.• Service to Hampshire and Isle of Wight• Face to face strategy discussions are working
well.• CP referrals are managed within 2 hours.• Children in Need referrals managed within 24
hours• Good support from Early help to improve Step
down
Current Position• CRT using SERAF tool to screen for
sexual exploitation
• Domestic Violence (Claire’s Law) and Sex Offenders (Sarah’s Law) Disclosure Service managed through CRT/MASH
• Temporary Child Protection Plans held within CRT for HCC and IOW
• Social workers on MASH now work shifts
Next Steps
• Potential for Probation to work from MASH once per week
• YOT trial of workers in MASH
• Police are recruiting extra officers and Staff
• Health have increased resources
• Work commenced to increase involvement of virtual partners.