Signs of Safety: Developments in Mid Yorkshire Hospitals NHS Trust (MYHT)

1. Signs of Safety: Developments in Mid Yorkshire Hospitals NHS Trust (MYHT) Kirsty Hill Named Nurse, Safeguarding Children Sally Ward Health Visitor

2. What we did! • Establishing Governance • Fully engaging with Local Authority implementation team • Representation on the sub groups • Mid Yorkshire Implementation Group

3. What we did! • Training our staff • Four practitioners on the five day training • All supervisors attended the two day training • All community staff attended one or half day training (latterly ‘in house’)

4. What we did! • Revising documentation and IT • All work undertaken with front line practitioners • Child Protection Conference Report • Request for service from social care • Creating a template on SystemOne

5. What were our challenges? • What do we do first? • Implementation in an organisation which just happens to deliver services to children! • I’ve been on the training!... What next?

6. Next Steps… • Skills development workshops • Quality Assurance • Celebration!

7. Safeguarding Supervision • Supervision has been transformed since the introduction of the signs of safety model across MYHT. • The model adds structure to each verbal discussion about families which in turn standardises the quality of supervisions • Record keeping of supervision reflects the model and this adds clarity and structure to the patient records • Every Supervisor has been offered prompt card guidance as a resource to use in supervision. This can help with appropriate lines of questioning and ensure structure to the meeting. Supervisors can follow simple step-by step guidance creating more confidence in using the model until more experience is gained.

8. Family Work The model is now been used in community health by the 0-19 service. It has been particularly useful when support is required for families where the case is not in the safeguarding arena and there is no statutory plan. • Where worries remain • Where engagement with services is poor • Where parents are not proactive in achieving goals or making changes • Where there is complex health needs • When it is difficult to know how to improve the situation The model has been used for health and social worries where the case does not meet the referral criteria or threshold for family services or the early help hub. It can be used when a CAF plan has been declined by a family to structure single agency care planning.

10. Challenges • Staff were trained and excited to use the model in practice however MYHT IT systems for record keeping were not ready. • It is important in supervision and in practice to use Signs of safety in a child centred way. Supervision can become practitioner centred and family plans can become parent focused.

11. Case Studies Health visiting scenarios from practice: • A single father whose daughter has complex additional needs who was not accessing any health care or education. I was concerned that this was due to wilful neglect. The child could not communicate and was vulnerable. CAF was declined and her father was not interested in her accessing nursey.

12. Case Studies Health visiting scenarios from practice: • A mother of two who was supported to leave her husband to flee domestic abuse. She had no finances, lost her job, was very tearful at home and her children were observing this. She could not afford food or school clothing and needed support accessing legal advice about the safety of her children.

13. Case Studies Health visiting scenarios from practice: • A young mum who struggled to cope with the behaviour of her son who is autistic. Mum was low in mood/ tearful; telling me she cannot cope anymore and has ‘had enough’. She was defensive and confrontational when offered support and had a fall out with nursery staff. She declined a CAF and would not access any other services for additional support. She wanted to quit her job as she was so tired, but wanted to be at work because she couldn’t cope with her son.

15. 6 weeks’ later • Carrianne will ask her mum for extra support caring for Charlie and for breaks: ACHIEVED - THEY ARE NOW LIVING WITH MATERNAL GRANDMA INCREASING PRACTICAL, EMOTIONAL AND FINANCIAL SUPPORT • Carrieanne has accepted referral to community nursery nurse Rachel who will visit at home to review use of behaviour management strategies. Carrieanne will work with Rachel to come up with some strategies to trial and review. ACHIEVED • Consider GP appointment for Charlie if he continues to find it hard to fall asleep at night. NO LONGER WORRIED • Health visitor to liaise with S&LT about when the next assessment will be. ACHIEVED • Charlie to attend Ear, nose and throat appointments and paediatrics appointments as planned. ONGOING • Charlie to have pre-5 assessment in nursery with educational psychologist. NO LONGER REQUIRED • Carrieanne will continue to have open access to VIP young parent group for emotional support and friendship. She will use this to seek additional support if she ever feels low in mood. ONGOING • Carrianne will continue to go to work and make changes to her shifts to make it easier for her to rest and care for Charlie ACHIEVED

16. After 6 weeks...

17. But what does it mean for families?

18. Any Questions….