A Conference on Joint Working in Hampshire

1. A Conference on Joint Working in Hampshire

2. Housekeeping • Alarms • Toilets • Smoking • Breaks • Register

3. Learning Outcomes • Promote the use of the three revised 4LSCB protocols • Raise understanding of how to use the protocols • Explore challenges to implementation • Consider changes in practice

4. Agenda 0945 - Keynote address 1000 – Introduction to the protocols 1045 - Tea/coffee 1115 - Case study exercise 1230 - Plenary session 1300 – Close

5. Next Steps • Raise awareness within your organisation. • Promote and ensure use in practice and supervision. • Auditing of use and compliance.

6. END • Presentations will be sent out. • Please complete the survey monkey evaluation. • Have a safe journey home!

7. HSCB Conference: Joint Working in Hampshire Andrea O’Connell Director of Quality: West Hampshire Clinical Commissioning Group

9. 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

10. ‘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

11. 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

12. 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

13. Joint Working ProtocolUpdate February 2014 Sheila Hodgkinson and Helen Hudson Safeguarding Children Team Hampshire Hospitals Foundation Trust

14. 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

15. 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.

16. 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

17. 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

18. 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.

19. 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

20. In conclusion – main changes • Consider Early Help • Information sharing • Planning in pregnancy weeks, no one told the baby their due date. • Any questions

21. 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

22. 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

23. 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

24. 4LSCB bruising protocol2013 revision Jean Price February 2014

25. 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.

26. Case example • Doctor treated her for slight infection, and agreed to follow up 3 days later. • Child was on life support and died

27. 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

28. Case example • Post Mortem - subdural haemorrhage facial and body bruising 3 fractured ribs

29. 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

30. Bruising protocol • First developed 2010 • Concerns re professionals not appreciating the possible seriousness of bruises(small) infants • Reflected in National SCR’s

31. Shaken babies Serious • Loss of consciousness • Coma • Collapse • Apnoea (breathing difficulties) • Fits Mild • Poor feeding • Irritability • Lethargy • Vomiting • Isolated fit

32. 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

33. 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

34. 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)

35. 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

36. 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)

37. 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

38. Revised Protocol (2) • A seriously ill or injured infant should be referred to hospital immediately • Inform Social Care

39. 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)

40. 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

42. Thank you Jean Price Designated Doctor Southwest Hants CCG