Child Safeguarding Protocol In EMIS Web Jez McCole, GP, Gleadless Medical Centre, Sheffield @jezmccole

The Problem Lack of awareness of Safeguarding issues Common to most busy surgeries What is already in the busy record? What was the point of coding it? Coding is more than just about QOF Bringing the electronic medical record to life Highlighted during our Three Minute Surgery

Theme 2 - Everything is ok This theme demonstrated how professionals didn’t recognise the safeguarding issues or vulnerabilities that existed. There were 2 main reasons for this: 1. Normal for Community. In 3 cases professionals felt that the children were one of a ‘number of children like this’ in the community: ‘There are lots of other families like this in their practice area so this family would not have stood out. This is of concern… because of the clear level of risk that there was in this family.’ (2011) 2. Misplaced Optimism. There was evidence (in 8 cases) of professionals working with an overoptimistic view of the situation. The most common reason was that they didn’t question, recognise, know or collate the family history or vulnerabilities that exist. ‘Assessments failed to consider the historical information regarding this couple. Agencies failed to consider the multiple risk factors’ (2011) Normal for community Professionals viewing the child(ren) as one of ‘a number of children like this’ can lead to lower expectations of parenting and increasing the ‘threshold’ for referral for additional services.

Theme 3 - Assessment, Assessment, Assessment This highlights the importance of assessment and the difficulties that arise when this isn’t thoroughly completed. An Assessment Mindset is seeing every encounter with a family as an opportunity to re-evaluate the situation. The lack of this was an issue in 6 cases. Silo Thinking. In 6 cases professionals viewed situations in isolation, were task focused and ‘episodic’. This also highlighted where professionals didn’t consider the possible impact of the parents mental health on their parenting. Downgrading of risk (4 recent cases). In these professionals closed cases when there was no evidence of any new information to inform this decision. Recognition of risk by universal services. 3 cases highlighted that although universal services had contact with a family, they didn’t recognise the circumstances the children were living in. Communication and information sharing was an issue in 10 reviews. 1. Assessment Mindset Working without an ‘assessment mindset’ can be due to a number of reasons including: working with the ‘start again approach’ - a failure to take account of past history and starting again. This has been recognised nationally (Brandon, Belderson & Warren (2008)) Assessments getting stuck – reaching a conclusion regarding an aspect of the case and not changing from this opinion even when new information contradicted this. This was highlighted as an issue by Munro (1999, quoted in Burton, 2009) ‘Professionals need to constantly guard against the tendency to cling to their original beliefs and overlook, devalue or re-frame any new information that challenges those beliefs’. Assessments lacked rigour – new information was available but services didn’t use this. This was an issue across agencies but particularly for Children’s Social Care. ‘It is what is done with information, rather than its simple accumulation, that leads to more analytic assessments and safer practice.’ (Brandon et al, 2008) Assessment Tools – in 7 reviews assessment tools were not used when these could have added to the information available. These mainly referred to the CAF. In addition, recent reviews demonstrated this is being viewed as a referral, not an assessment tool. 2. Silo Thinking Ofsted (2010) analysis of SCR completed in 2009 – 10 reported that ‘Agencies tended to respond reactively to each situation rather than seeing the whole context’. An example of this in one of the local reviews: ‘Analysis of concerns may also have been downgraded by the treatment of incidents in isolation rather than as part of a pattern indicating long term difficulties and growing stress and tensions within the family’ (2011) 3. Downgrading of risk This was a particular issue for Children’s Social Care and one decision made by the Children’s Hospital 4. Recognition of risk by universal services Two of the 3 cases were very recent ones. The importance of the role of universal services has been highlighted nationally. In an analysis of SCR published between 2007 – 09 approximately half of all cases ‘are in relation to babies under one year of age, underlining the importance of effective universal services provision for young children e.g. health visitors’ (Brandon, Bailey & Belderson, 2010) 5. Communication and information sharing The local results were in line with national findings, ‘as in all other studies of serious case reviews, communication problems among agencies and professionals were common’ (Brandon et al, 2008). Locally, there were particular issues for various health agencies and children’s social care.

Three Minute Surgery GP HCA Room1 HCA Room2 Distraction N = 40+

Our Aims When any record is loaded To present the Child Protection Status of the patient To inform the user about Safeguarding procedures

Protocol Overview – The finished product

Protocol Ingredients A coded record Concepts Connectors Protocol Alerts (‘Zap box’)

A (well) Coded Record Agree your codes Used on the record of the child [13Iv] Child is the subject of a Child Protection Plan [13Iw] Child has been removed from a plan [13IO] [13IS] Child is a Child in Need [13IT] Child is no longer a Child in Need Used on the record of a parent/guardian [13Iy] Family member subject of a Child Protection Plan [13Iz] Family member removed from a Child Protection Plan

THE CONCEPTS The engines of the protocol Interrogate the record Change the direction of flow based on what they find Written in the Concept Manager

Creating a Concept 1

Creating a Concept 2

Create a Protocol

Starts as a blank canvas Build the Protocol Starts as a blank canvas

Add a pre-prepared Concept

Protocol Flow – Child currently on a plan

Protocol Alerts - ‘Zap’

Protocol Alerts

Safeguarding Template

Safeguarding Template

Protocol Overview – Child currently on a plan

Protocol Overview – Child no longer on a Plan

Concept & Alert Alert No Longer on a Plan Concept

Protocol Overview – The finished product

…and finally!

Program the trigger Update Record Thank you

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