Safeguarding Children Level 3 Training for General Practitioners

Safeguarding Children Level 3 Training for General Practitioners Jonathan Leach Director Primary Care/Named GP Catherine Whitehouse Consultant Nurse Adrian Todd Detective Inspector West Mercia Constabulary Find out more online: www. worcestershire. nhs. uk

Looking at the National Picture How big is the problem? ● In 2009 -10 88, 700 children 0 -18 years subject to child protection investigation (s 47 Children Act 1989) ● ● 50% of that number 44, 300 children were made subject of Child Protection Plans ● Maltreatment figures are much higher from reported children’s experiences (Childline and NSPCC online surveys) ● 2. 5% under 11 years and 6% 11 -17 years had experienced maltreatment from a caregiver in the previous year. Numbers of children suffering or likely to suffer significant harm has increased by 30% over the last two years following the circumstances surrounding the death of Peter Connelly which emerged early in 2009. Find out more online: www. worcestershire. nhs. uk

Headline Messages ● Emotional abuse and neglect – damaging and corrosive impact on children’s long-term life chances. Often comes to light through ‘crisis’ incident or injury ● Impact of maltreatment on babies in utero and in first two years particularly damaging ● Co-existing parental problems ● Witnessing domestic abuse- damaging form of emotional abuse, harms babies as young as 9 months ● Pregnancy – high risk period for domestic abuse ● Adolescent neglect – difficult to identify, often goes unnoticed Find out more online: www. worcestershire. nhs. uk

Emerging Patterns in Worcestershire ● 120, 000 children and young people 0 -18 years ● 400 currently subject to Child Protection Plans (CPP) ● 600 Looked After Children ● Highest category - 47% of children subject to CPP for neglect. ● Often associated with ‘toxic mix’ parental mental health difficulties, domestic abuse and chaotic drug or alcohol misuse ● General Practitioners see on average 2 new safeguarding cases per year Find out more online: www. worcestershire. nhs. uk

Processes and Systems ● New Threshold Guidance for Practitioners launched in September 2011 outlining process and detailing sharing of information ● All referrals routed through one Access Centre Children’s Social Care ● Three Social Workers available to undertake professional conversation with referrer and explain decision making. ● Police Officer will also be based in the Access Centre to enable linking of domestic abuse information ● Designated and Named Professional’s available through NHS Worcestershire and Worcestershire Health and Care Trust for advice and support in relation to safeguarding concerns. Find out more online: www. worcestershire. nhs. uk

Information Sharing and Understanding Thresholds Find out more online: www. worcestershire. nhs. uk

Views of General Practitioners The Child, The family and The GP: Tensions and Conflicts of Interest in Safeguarding Children (April 2009) ● See role as referring patients or families on where concerns were raised ● Supporting parents seen as best way to support children – where serious harm or likelihood of harm evident, the child’s interests must come first ● GPs are clear ‘what to do’ if situation is clear cut CP issue ● More complicated issues often seek advice from Paediatrician or Health Visitor first ● Lack of confidence in responses from Children’s Social Care. Find out more online: www. worcestershire. nhs. uk

Guidance on Information Sharing ● General Medical Council – Confidentiality and Information Sharing ● ‘See the adult behind the child’ and ‘see the child behind the adult’ or “think family, not individual” ● Safeguarding Children and Young People –A Toolkit for General Practice (2010) Find out more online: www. worcestershire. nhs. uk

Good Practice ● Talking to Parents and to young people about concerns and involving them in decisions to share information ● Taking time to assess, reassure and consider a response ● Arranging for follow up ● Allocating separate GPs to parent and child if conflict of interest Find out more online: www. worcestershire. nhs. uk

Good Practice ● Sharing worries with other colleagues and engaging in significant event analysis ● Utilising the skills of Designated and Named professional’s, Paediatricians ● Training and case discussion within the practice ● Carefully recording decisions ● Use “pop ups” on computers Find out more online: www. worcestershire. nhs. uk

Inter-Agency Working The Role of the Police Find out more online: www. worcestershire. nhs. uk

Learning From Serious Case Reviews and Multi-Agency Case File Audits Find out more online: www. worcestershire. nhs. uk

All babies count: NSPCC November 2011 ● Almost half of all SCR involve a child under one ● Large proportion relate to first three months of life ● Practitioner’s underestimate the fragility of the baby ● Under one more likely to suffer neglect and abuse than a child of any other age. Find out more online: www. worcestershire. nhs. uk

Analysis of Serious Case Reviews in Worcestershire 2007 -2011 Profile ● 5 out of 8 children under one year ● 1 of 8 cases was aged 16 years Cause of Death ● 2 cases Head Injury ● 1 case Physical Abuse ● 1 case Suffocation, Burns and Head Injury ● 1 case Hypothermia/Drowning ● 2 cases unascertained Find out more online: www. worcestershire. nhs. uk

Previous Contact with Agencies ● None of the children were subject to CPP at the time of injury/death But. . . . ● In 2 cases CPP previously in place ● In 2 cases CPP had been in place for their siblings ● In 2 cases older sibling had been a Looked After Child or placed for adoption Find out more online: www. worcestershire. nhs. uk

Parental History ● Parents often had history of abuse and neglect in childhood ● Frequent history of being subject to CPP or being Looked After by LA ● Frequent moves of address ● Criminal behaviour Find out more online: www. worcestershire. nhs. uk

Emerging Themes ● Parental Mental Health Difficulties ● Substance Misuse ● Resistant Families (Fathers) ● Homelessness ● Domestic Abuse Find out more online: www. worcestershire. nhs. uk

Pointers for Practice ● Vulnerability of very young children ● Important role of universal services e. g Health and Police ● Importance of effective information sharing between agencies ● Need for agencies to have processes for escalating concerns ● Importance of accessing advice from Safeguarding Leads Find out more online: www. worcestershire. nhs. uk