A Conference on Joint Working in Hampshire
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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
Andover War Memorial Hospital Basingstoke and North Hampshire Hospital Royal Hampshire County Hospital
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
Andover War Memorial Hospital Basingstoke and North Hampshire Hospital Royal Hampshire County Hospital
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.
Andover War Memorial Hospital Basingstoke and North Hampshire Hospital Royal Hampshire County Hospital
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
Andover War Memorial Hospital Basingstoke and North Hampshire Hospital Royal Hampshire County Hospital
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
Andover War Memorial Hospital Basingstoke and North Hampshire Hospital Royal Hampshire County Hospital
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.
Andover War Memorial Hospital Basingstoke and North Hampshire Hospital Royal Hampshire County Hospital
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
Andover War Memorial Hospital Basingstoke and North Hampshire Hospital Royal Hampshire County Hospital
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
Safeguarding children whose parents/carers have problems with mental health,
substance misuse, learning disability and emotional/psychological distress
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
Safeguarding children whose parents/carers have problems with mental health,
substance misuse, learning disability and emotional/psychological distress
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
Revised protocol (3)
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)
Revised protocol (4)
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
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