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GP Update 2015 (Level 3)

GP Update 2015 (Level 3). Helen Mutch, Named GP Sandy Marwick, Independent Social Worker 2015. Learning objectives. To understand what constitutes child maltreatment and identifying features

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GP Update 2015 (Level 3)

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  1. GP Update 2015(Level 3) Helen Mutch, Named GP Sandy Marwick, Independent Social Worker 2015

  2. Learning objectives • To understand what constitutes child maltreatment and identifying features • To understand the local and national framework, including service reorganisations, serious case review messages and recent developments • To gain confidence in managing potential safeguarding issues by reflecting on cases.

  3. Case Scenarios • Background information • Useful resources and Guidelines • Local multi-agency working and serious case reviews • Questions

  4. Case Scenarios

  5. When discussing the following case scenarios please consider the following four points: • 1. WHAT FACTORS DO YOU NEED TO CONSIDER? • 2. WHAT FACTORS WOULD HEIGHTEN CONCERN? • 3. WHAT FACTORS WOULD REASSURE YOU? • 4. WHAT WOULD YOU DO NEXT?

  6. You have a patient who has been on a long term methadone script and becomes pregnant. You refer her to specialist services for drug using mothers but she does not attend.

  7. A teenage girl known to you consults on a busy Monday afternoon. She attends with her older boyfriend. She is asking for emergency contraception after a condom had split following intercourse on Saturday. She sits holding her boyfriends hand throughout and says her parents mustn't find out as they would kill her. She will be thirteen the following day.

  8. A patient comes to see you asking for contraception as she is in a new relationship. After you have finished consulting her she asks you to check her 4 month old baby over as she has a bad cough and fever. • While listening to her chest you notice a small bruise on the baby’s chest which mother explains was caused by the baby’s older brother.

  9. A 13 year old boy is brought to you by his mother. He has been excluded from school following a fight where he punched and kicked another student. Mum says they want him referred to CAMHS before he can go back. You have seen the mother previously for depression. The boy isn’t very communicative. When asked about his behaviour at home his mother says there is a lot of arguing between him and her partner but she is unwilling to say much more.

  10. A mother attends the surgery with difficulty passing urine. She has recently given birth to a baby girl. She has 2 other children at home 1 girl aged 6 and a boy aged 3. her country of origin is the Sudan

  11. A 16 year old girl comes to see you asking for sleeping tablets. She says there have been a lot of break-ins round where she lives and she is scared at night. She isn’t well known to you but from her notes you see that she lives with her grandmother and her uncle. She is very overweight and has seen the nurse practitioner several times about painful periods.

  12. What can GPs do? • Record concerns in the primary care electronic health record • Discuss the matter with colleagues • Arrange for monitoring/seeing the child or YP (you or another health professional) • Regular practice meetings to discuss management of vulnerable families. • REFER

  13. Families should be referred on to social workers either because they need support services that the local authority can provide (for example respite care for a disabled child) or because there are concerns about abuse or neglect. • Referral threshold guidance 2014: • http://www.bristol.gov.uk/sites/default/files/documents/children_and_young_people/child_health_and_welfare/Final%20Thresholds%20guidance%20February%202014.pdf

  14. Questions to ask yourself: • •If nothing changes, or if I do nothing, in what way is the child likely to be harmed? • •What is it I am most worried about? • •Have I asked consent from the parent (and child where appropriate) to share this information? (and if not, why not?) • •What is prompting me to ask for help or support now? Has the problem or issue got worse recently? • •What needs or concerns have been identified? • •What has already been done to address the needs or concerns? (including actions by other agencies where known). • •What positive resources and abilities do the child and family currently • have? • •What do we already know about the child’s development issues and parental capacity within the family?

  15. Coding • Recording • Scanning • Family key - EMIS • Safeguarding protocol • DNA policy • Communication policy • Information sharing

  16. Useful codes • Subject to child protection plan 13Iv • No longer subject to child protection plan 3Iw • Child protection Case conference 3875 • Child in need 13Is • Vulnerable child 13IF-1 • vulnerable family 13Iq • Victim of domestic abuse 14XG • Domestic abuse victim in household 13WD

  17. Issues for sessional GPs and STs • Communication – PN/task to usual GP • Link/lead GPs – email or PN/task • Coding • Locum packs/folders • Local contact numbers • If in doubt discuss. Within practice or with named GP/designated nurse

  18. The Child Abuse Jigsaw Other third party information Parents’ and Family History Child’s Disclosure Behaviour Past Medical History Medical Investigations Growth and Development Physical Examination Information from School, Health Visitor and GP

  19. Useful resources (1) • GMC guidance – protecting children and young people: • http://www.gmc-uk.org/static/documents/content/Child_protection_guidance_update_25_4_13.pdf • Bristol safeguarding board: • http://www.bristol.gov.uk/page/children-and-young-people/bscb-protocols-multi-agency-action • South West Safeguarding Procedures: • http://www.swcpp.org.uk • summary of Working Together 2013 – by NSPCC • http://www.nspcc.org.uk/inform/research/briefings/Working_together_2013_wda95001.html#summary • BSCB Threshold Guidance 2014 • http://www.bristol.gov.uk/page/children-and-young-people/bristol-safeguarding-children-board

  20. Useful resources (2) • NICE – when to suspect child maltreatment March 2013 • http://www.nice.org.uk/nicemedia/live/12183/44914/44914.pdf • forced marriage and honour violence • http://www.karmanirvana.org.uk/ • Serious case review themes • http://www.nspcc.org.uk/Inform/resourcesforprofessionals/scrs/at-a-glance-briefings_wda99475.html • Child sexual exploitation – spotting the signs toolkit • http://www.bashh.org/documents/Spotting-the-signs-CSE-%20a%20national%20proforma%20April%202014%20online.pdf • sexual Violence Referral Pathway http://www.survivorpathway.org.uk/bristol/

  21. Useful Resources (3) • NSPCC collate all eth Serious case reviews across the UK, they also undertake thematic reviews of key concerns http://www.nspcc.org.uk/Inform/resourcesforprofessionals/serious_case_reviews_homepage_wda82779.html • Safeguarding Children’s training: e-learning Package http://www.e-lfh.org.uk/programmes/safeguarding-children/ • Female genital Mutilation –Resource Pack https://www.gov.uk/government/publications/female-genital-mutilation-resource-pack/female-genital-mutilation-resource-pack • E-learning Package on Female Genital Mutilation http://www.fgmelearning.co.uk/

  22. Young People Under 16 Involved in Sexual Activity Fraser Guidelines • Can you give contraceptive and sexual health advice and information to under 16 year olds without parental consent? • Are you satisfied that: • The young person can understand the advice and has sufficient maturity to understand what is involved in terms of the moral, social and emotional implications. • You can’t persuade the young person to inform their parents, nor allow you to inform their parents that contraceptive advice is being sought. • The young person would be very likely to begin or to continue having sexual intercourse with or without contraceptive treatment. • Without contraceptive treatment the young person’s physical or mental health or both would be likely to suffer. • The young person’s best interests requires the professional to give advice without parental consent.

  23. Bichard checklist • Should you tell the police and social services? • Do any of the following apply: • • Age or power imbalances • • Overt aggression • • Coercion or bribery • • The misuse of substances as a disinhibitor • • Does the child’s own behaviour, because of the misuse of substances, place him/her at risk so that he/she is unable to make an informed choice about any activity? • • Has any attempt to secure secrecy been made by the sexual partner, beyond what would be considered usual in a teenage relationship? • • Is the sexual partner known by one of the agencies (n.b. police)? • • Does the child deny, minimise or accept concerns? • • Are the methods used consistent with grooming?

  24. Safeguarding and substance misuse • Risk assessment ( including partner) • Prescribing • Safety of medicines • Neglect and abuse • Shared care protocol

  25. Local services CYPS/Multiagency • First Response ( Bristol) • First Point ( S Glos) • Early help • New team structure 2015 Police • Public Protection Unit (PPU) organisation MARAC Child Sexual Exploitation (CSE) FGM

  26. Contact details and information for referrals First response - Bristol • Telephone: 0117 9036444 • http://www.bristol.gov.uk/page/children-and-young-people/report-concerns-about-child-social-worker-first-response • First Point = (South Gloucestershire’s First Pointis a single point of access to children's preventative and social care and specialist services, their telephone number is 01454 866000 and their email isfirstpoint@southglos.gov.uk • Out of hours Emergency Duty Team- 01454 615165 • North Somerset Children’s Services, Single Point of Access: 01275 888808

  27. Signs of safety • Systems based approach to assessing and planning safeguarding work with children and families • Solution focussed • https://www.nspcc.org.uk/Inform/research/findings/signs-of-safety-pdf_wdf94939.pdf

  28. Local SCRs • Child M 2010- toddler who drowned in pond • Child N 2010 – 10 yr child stabbed by mother • Children A & Z 2011 – 2 children 7 & 5 year old died in a house fire • Child K 2012- toddler died from methadone ingestion • Child T 2013 – not yet published • Sarah- Current Bristol SCR • South Glouc about to publish their latest SCR

  29. Telephone numbers for routine advice and support: NHS BRISTOL and BRISTOL COMMUNITY HEALTH • Designated Doctor for all Bristol Trusts and NHS South Gloucestershire: Dr Maria BredowTel: 0117 9002670 Email: maria.bredow@nbt.nhs.uk • Designated Nurse for Safeguarding Children: Jackie Mathers. 4th Floor, South Plaza, Tel: 0117 9002670, Email: jackie.mathers@bristolccg.nhs.uk • Deputy Designated Nurse for Safeguarding Children:Julie Henderson. Email julie.henderson@bristolccg.nhs.uk • Named GP for Safeguarding Children: Dr Helen Mutch 0117 9640900 Mob: 07768414789The Lennard Surgery. helen.mutch@gp-l81053.nhs.uk

  30. Summing up • Questions • Contact • Helen Mutch

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