1. DISCHARGE AND SAFETY PLANNING PROTOCOL FOR CHILDREN AND YOUNG PEOPLE ADMITTED TO HOSPITAL

2. Welcome and Introductions
Purpose of the protocol – to support multi-agency practitioners to make appropriate arrangements for the safe and timely discharge of children under 18 years of age
Scope – CYP who need a multi-agency response to their needs due to:
Serious or complex mental health needs requiring hospital admission
Self-harm or attempted suicide
Other health needs where there are safeguarding and/or other welfare concerns

3. Underpinning Principles
Children who self-harm / express suicidal ideas will always be taken seriously and provided with appropriate help and support
Most admissions for mental health needs will require follow-up community support after discharge
Discharge planning is an essential part of care management in the hospital setting and will ensure that the right health and social care support is put in place
Children should not remain in hospital once they are well enough to leave
Where there are safeguarding concerns a referral should be made to the Newham MASH (multi-agency safeguarding hub)

4. The Discharge Planning Process
The hospital lead the process
Attendees: Medical or Duty Consultant or their delegate; Ward Nursing staff; CAMHs practitioner; Social worker and Practice Leader from Children’s Social Care (where there are safeguarding concerns)
Convened at least 24 hours before planned discharge
May double as a child protection meeting – if required
The hospital will chair the meeting, record and circulate the discharge plan. In cases where Children’s Social Care are involved they will hold the chairing responsibility.
Agenda and Template for the DPM developed as part of the protocol (Appendix 1)
As mentioned this protocol covers all discharges which require a multi-agency response – however the focus of this session is on situations involving self-harm and the learning arising from the Child J SCR that the next speaker will be talking about

5. Data: Child Mental Health 2016/17
The rate of self harm and suicide attempts in children is lower than the national average.
Newham hospital admissions as a result of self harm in yr. olds: 278/100,000 young people (England average is 423/100,000). Completed suicide rate/100,000 population in Newham: 7.4/1000,000 population (all ages) (England average is 10.1).
Two young people in Newham committed suicide in
Newham LSCB carried out serious case reviews in both cases and the learning from these has been widely shared within the partnership
Majority of children who present after deliberate self-harm do very well, engaging with support and treatment after their crisis, particularly where there is good multi-agency input

6. Child J serious case review: Children’s Social Care
J was a 15 year old boy who took his own life within weeks of being discharged from NUH where he had been admitted after an episode of deliberate self-harm
Serious case review identified missed opportunities and weaknesses in the discharge planning and follow up for J
SCR has been a key driver in developing the protocol

7. Early help offer – not joined up No single multiagency safety plan
Missed Opportunities
Early help offer – not joined up
No single multiagency safety plan
Child J had multiple presentations at A&E and his GP from the age of 10 years and before he started self-harming but this did not lead to an EH assessment.
While a discharge planning meeting was held in February this did not develop a shared multi-agency plan and one agency (ELFT) was left holding the risk.

8. Working Together: collaboration is key to success
There is likely to be very limited time to pull information and people together so all safeguarding partners need to make discharge planning and priority
There may be 2 lead professionals – a health clinician and a social worker
Schools will hold vital information and need to contribute to the process
The need for a protocol was reinforced by a multi-agency case file audit carried out at then end of 2017 and by the number of cases this year which required escalation due to a lack of joined up working

9. Children’s Social Care Roles and responsibilities
Review and respond to referrals to the MASH to determine level of support required (within 24 hours)
early help or targeted support (through the EH framework)
Statutory interventions(requiring a social worker):
child in need
child protection
Allocated social worker will meet with the young person and their family to begin a child in need assessment
Arrange and chair multi-agency strategy meeting if there are child protection concerns and complete section 47 enquires (within 15 working days)
Arrange an alternative placement if the child cannot safely return home
Not all cases involving complex mental health will require a social worker. Cases may be stepped up or down on completion of enquiries/assessments

10. Child and Adolescent Mental health services
Are expected to assess within 4 hours of admission to ED or the next day if the young person has been admitted overnight
Record the assessment of Rio and share with ward staff to develop a joint care plan
Undertake risk assessment and evaluate ongoing risk
Assess capacity of young person to make health decisions for themselves. Important for year olds
Meet with parent/carers to corroborate history, evaluate relationships and ascertain their support in risk management.
Formulate a treatment plan and follow up in the community – 7day follow up appt offered by CAMHS
Daily discussion with acute ward
Update CSC where there are safeguarding issues

11. Discharge plan: shared responsibility
Initiated by the Hospital - the meeting will cover:
Background and reasons for admission
Outcome of assessments
Child’s voice and experience
Develop the discharge/safety plan which will specify:
Presenting issues, triggers, warning signs
Protective factors
Treatment and support plan with timescales
Outcomes to be achieved
Visiting arrangements (1st visit within 48 hours of discharge, arrangements for weekends, holidays – if required
Status and ownership of the plan / Interface with other plans
Details of lead professional(s)
Follow up meetings

12. Voices of young people

13. Break and Networking

14. Using the Protocol Group work

15. Panel Time

16. Next steps
Named leads from Bart’s, CSC and ELFT will be tracking live cases and reporting back to the LSCB on the impact of the protocol There will be a follow up multi-agency case file audit in early 2019 LSCB provides briefings on serious case reviews and training on self-harm. For more information go to