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Safeguarding Children booklet - Hampshire and Isle of Wight LPC

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Solent NHS Trust<br />

NHS Portsmouth<br />

NHS Southampton City<br />

Everyone’s<br />

responsibility<br />

<strong>Safeguarding</strong><br />

<strong>Children</strong><br />

Practitioner<br />

H<strong>and</strong>book


Good parenting involves caring for children’s basic<br />

needs, keeping them safe <strong>and</strong> protected, being<br />

attentive <strong>and</strong> showing them warmth <strong>and</strong> love,<br />

encouraging them to<br />

express their views <strong>and</strong><br />

consistently taking<br />

these views into<br />

account, <strong>and</strong><br />

providing the<br />

stimulation<br />

needed for<br />

their development<br />

<strong>and</strong> to help them<br />

achieve their<br />

potential, within<br />

a stable<br />

environment<br />

where they<br />

experience<br />

consistent<br />

guidance <strong>and</strong><br />

boundaries.<br />

(HM Government, 2010)


<strong>Safeguarding</strong> <strong>Children</strong>: Practitioner H<strong>and</strong>book<br />

Welcome to the <strong>Safeguarding</strong> <strong>and</strong> Child Protection Practitioner<br />

H<strong>and</strong>book. The h<strong>and</strong>book 1 has been written for all health care<br />

staff <strong>and</strong> complements organisational policies on safeguarding<br />

children. Importantly, it aims to provide information, help <strong>and</strong><br />

advice in dealing with concerns about the safety <strong>and</strong><br />

well-being <strong>of</strong> a child or young person.<br />

The starting point is that safeguarding children is ‘Everyone’s<br />

Responsibility’ <strong>and</strong> that, as part <strong>of</strong> your role, you have a<br />

statutory duty to safeguard <strong>and</strong> promote the welfare <strong>of</strong> children<br />

<strong>and</strong> young people. This applies to you whether you work<br />

directly or indirectly with children <strong>and</strong> young people, or with<br />

their parents or carers. You also belong to a local community<br />

<strong>and</strong> may find yourself concerned about a child, young person or<br />

their family outside <strong>of</strong> your work. You can be the one to make a<br />

difference.<br />

In underst<strong>and</strong>ing your safeguarding role it can be helpful<br />

to consider what it is that children <strong>and</strong> young people need<br />

to ensure that they have a good journey throughout their<br />

childhood. In most cases these needs will be met by parents:<br />

‘Good parenting involves caring for children’s basic needs,<br />

keeping them safe <strong>and</strong> protected, being attentive <strong>and</strong><br />

showing them warmth <strong>and</strong> love, encouraging them to<br />

express their views <strong>and</strong> consistently taking these views<br />

into account, <strong>and</strong> providing the stimulation needed for their<br />

development <strong>and</strong> to help them achieve their potential,<br />

within a stable environment where they experience<br />

consistent guidance <strong>and</strong> boundaries.’<br />

(HM Government, 2010) 2<br />

1<br />

This <strong>booklet</strong> is an updated version <strong>of</strong> the Practitioner H<strong>and</strong>book<br />

circulated to Portsmouth City PCT staff in 2009.<br />

2<br />

See http://www.workingtogetheronline.co.uk/index.html


Whilst there are some indications that the situation in the<br />

United Kingdom (UK) is improving, a significant minority 3<br />

<strong>of</strong> children <strong>and</strong> young people will experience<br />

some form <strong>of</strong> child maltreatment (abuse <strong>and</strong><br />

neglect) during their childhood, with<br />

parents <strong>and</strong> carers as the most<br />

likely people responsible.<br />

The risk <strong>of</strong><br />

maltreatment<br />

is greater<br />

where parents<br />

have multiple<br />

<strong>and</strong> complex<br />

needs; especially<br />

the ‘toxic trio’ <strong>of</strong><br />

substance abuse,<br />

mental health<br />

problems <strong>and</strong><br />

domestic abuse. Many<br />

practitioners will meet<br />

patients <strong>and</strong> clients<br />

with such issues in the<br />

course <strong>of</strong> their work.<br />

Where practitioners are providing care to these vulnerable<br />

people it is always important to make an assessment <strong>of</strong> the<br />

needs <strong>and</strong> best interests <strong>of</strong> any children in the household<br />

<strong>and</strong> to seek help <strong>and</strong> share information accordingly.<br />

3<br />

NSPCC (2011) Child Cruelty in the UK 2011: An NSPCC study into<br />

childhood abuse <strong>and</strong> neglect over the past 30 years. London: NSPCC


Although child deaths from maltreatment (child abuse <strong>and</strong><br />

neglect) are a rare event, they are important in terms <strong>of</strong><br />

learning lessons to prevent future tragedies. As part <strong>of</strong> the<br />

Government response to the much publicised death <strong>of</strong> a toddler,<br />

widely known as ‘Baby Peter’, Lord Laming published a review<br />

<strong>of</strong> child protection in Engl<strong>and</strong> 4 . In his report, Laming delivers<br />

four messages that support excellence in safeguarding children<br />

practice. These are to:<br />

• Put yourself in the place <strong>of</strong> the child & consider first <strong>and</strong><br />

foremost how the situation must feel for them;<br />

• Be aware <strong>of</strong> how easy it is to find yourself justifying <strong>and</strong><br />

reassuring yourself that all is well, rather than taking a<br />

more objective consideration <strong>of</strong> what has occurred;<br />

• Recognise that sympathy for the parents<br />

can lead to your expectations <strong>of</strong> their<br />

parenting being set too low;<br />

• Remember that<br />

whatever role you<br />

have (i.e. working<br />

with the child or<br />

their parents/carers or<br />

as a member <strong>of</strong> the<br />

public) be clear that it is<br />

not acceptable to do<br />

nothing when a child<br />

may be in need <strong>of</strong> help.<br />

4<br />

Laming, Lord (2009) The Protection <strong>of</strong> <strong>Children</strong> in Engl<strong>and</strong>:<br />

A Progress Report. London: The Stationery Office


These messages are at the heart <strong>of</strong> keeping children safe<br />

<strong>and</strong> are reflected in our vision for safeguarding children <strong>and</strong><br />

young people. <strong>Safeguarding</strong> children is indeed ‘Everyone’s<br />

responsibility’.<br />

Whether you are a frontline practitioner, or a manager, or you<br />

provide the crucial support services that enable the delivery<br />

<strong>of</strong> high quality health services, we hope that this practitioner<br />

h<strong>and</strong>book will help you to feel more confident in your<br />

safeguarding <strong>and</strong> child protection role <strong>and</strong> responsibilities.<br />

The information in this h<strong>and</strong>book is presented in ‘Q & A’<br />

format. We have attempted to cover the most commonly asked<br />

questions about safeguarding <strong>and</strong> child protection; this<br />

includes what to do if you need to know<br />

more <strong>and</strong> how to access advice<br />

<strong>and</strong> support.<br />

Catherine Powell<br />

Consultant<br />

(Designated) Nurse<br />

<strong>Safeguarding</strong><br />

<strong>Children</strong><br />

Lindsay Voss<br />

Designated Nurse<br />

<strong>Safeguarding</strong> <strong>Children</strong><br />

March 2011


What is ‘safeguarding <strong>and</strong> child protection’ <strong>and</strong><br />

why is it important<br />

Health services have a statutory duty to safeguard <strong>and</strong> promote<br />

the welfare <strong>of</strong> children <strong>and</strong> young people. This duty is reflected<br />

in the <strong>Children</strong> Act <strong>of</strong> 1989 <strong>and</strong> 2004. <strong>Safeguarding</strong> children<br />

is defined in national guidance as: ‘protecting children from<br />

maltreatment; preventing impairment <strong>of</strong> their health <strong>and</strong><br />

development, <strong>and</strong> ensuring that they are well-cared for’ (HM<br />

Government, 2010) 5 . The Care Quality Commission (2010)<br />

requires health service providers to safeguard people who use<br />

services from abuse. This is Outcome 7.<br />

Many safeguarding children activities are part <strong>of</strong> routine<br />

daily practice in health settings; for example pre-employment<br />

checks to ensure the suitability <strong>of</strong> staff to work with children;<br />

the protective effect <strong>of</strong> a practitioner’s support to vulnerable<br />

parents; positive parenting advice provided by a health visitor;<br />

the assessment <strong>of</strong> a child’s well-being as part <strong>of</strong> the Care<br />

Programme Approach <strong>and</strong> the advice provided by a sexual<br />

health worker to help support a young person’s choices in<br />

becoming sexually active. Such timely <strong>and</strong> helpful activities can<br />

ensure that children <strong>and</strong> young people stay safe <strong>and</strong> healthy.<br />

Pr<strong>of</strong>essor Eileen Munro who has undertaken a review <strong>of</strong> child<br />

protection for the Government, reports that she prefers the term<br />

‘early help’ to ‘early intervention’. This is because she believes<br />

that it carries a stronger connotation <strong>of</strong> working with families<br />

<strong>and</strong> supporting their aims <strong>and</strong> efforts to change. However,<br />

she adds that this does not take away from the fact that child<br />

protection work requires authoritative <strong>and</strong>, at times, coercive<br />

action to protect children <strong>and</strong> young people 6 .<br />

5<br />

Care Quality Commission (2010) Essential St<strong>and</strong>ards <strong>of</strong> quality <strong>and</strong><br />

safety. London: CQC.<br />

6<br />

Munro, E. (2011) The Munro Review <strong>of</strong> Child Protection Interim Report:<br />

The Child’s Journey. London: Department for Education.


<strong>Safeguarding</strong> children is also about protecting children from<br />

maltreatment (abuse <strong>and</strong> neglect) <strong>and</strong> recent policy appears to<br />

be returning to the use <strong>of</strong> the concept <strong>of</strong> ‘child protection’ to<br />

cover the ‘sharp end’ <strong>of</strong> safeguarding. A person may abuse or<br />

neglect a child by inflicting harm, or by failing to act to prevent<br />

harm.<br />

<strong>Children</strong> <strong>and</strong> young people may be abused in a family or in an<br />

institutional or community setting; by those known to them or,<br />

more rarely, by a stranger. Because <strong>of</strong> the range <strong>and</strong> spread<br />

<strong>of</strong> health services, practitioners are in a good position not only<br />

to recognise situations that may indicate that a child is ‘at risk’<br />

<strong>of</strong> maltreatment, but also to <strong>of</strong>fer early help where there are<br />

concerns about the welfare <strong>of</strong> a child.<br />

Most people will recognise that children can<br />

be harmed by a single traumatic<br />

event such as a non-accidental<br />

injury. However, it is also important<br />

to recognise that, more commonly,<br />

‘significant harm’ 7 to a child results<br />

from a compilation <strong>of</strong> adverse events<br />

that impact on, change or damage<br />

their health <strong>and</strong> development.<br />

This includes situations where children’s<br />

health <strong>and</strong> developmental needs are<br />

neglected. An important example <strong>of</strong> this<br />

is missed health appointments <strong>and</strong> we<br />

expect that all services will have a clear<br />

process to follow when children are ‘not<br />

brought’ to their appointment.<br />

7<br />

The <strong>Children</strong> Act 1989 introduced the concept <strong>of</strong> Significant Harm as the<br />

threshold which justifies compulsory intervention in family life in the<br />

best interests <strong>of</strong> children.


How is ‘a child’ defined in law<br />

The legal definition <strong>of</strong> ‘children’<br />

applies to those persons under 18<br />

years <strong>of</strong> age. This is important<br />

because young people aged 16 <strong>and</strong><br />

17 years may be accessing ‘adult’<br />

health services <strong>and</strong> facilities. This<br />

may include employment <strong>and</strong><br />

volunteering. Whilst ‘unborn<br />

children’ are not included in the legal<br />

definition <strong>of</strong> children, intervention to ensure their<br />

future well-being is encompassed within safeguarding<br />

children practice.<br />

Good practice in caring for children <strong>and</strong> young people means<br />

taking a ‘child-centred’ approach, seeking their views <strong>and</strong><br />

listening to, <strong>and</strong> respecting, what they have to say. Some <strong>of</strong><br />

the worst failures in safeguarding <strong>and</strong> child protection have<br />

occurred when pr<strong>of</strong>essionals have lost sight <strong>of</strong> the child <strong>and</strong><br />

concentrated instead on their relationship with the adults.<br />

Where a child is at risk <strong>of</strong>, or suffering from significant harm,<br />

the interests <strong>of</strong> the child override those <strong>of</strong> their parents or carers<br />

(<strong>Children</strong> Act 1989).<br />

Is child maltreatment common<br />

It is important to remember that the majority <strong>of</strong> children are<br />

well cared for, with many parents <strong>and</strong> carers succeeding in<br />

providing good parenting despite their own vulnerabilities <strong>and</strong><br />

challenges. It is difficult to be certain about how many children<br />

suffer from child maltreatment at any one time (after all this<br />

is largely a hidden problem), nevertheless the NSPCC research<br />

with children <strong>and</strong> young adults <strong>and</strong> adult ‘survivors’ suggests<br />

that one in four children <strong>and</strong> young people suffer some form<br />

<strong>of</strong> maltreatment during their childhood. Whilst this includes<br />

physical, sexual <strong>and</strong> emotional abuse, the most common form <strong>of</strong><br />

maltreatment is neglect.


Which children are ‘at risk’ from being abused or<br />

neglected<br />

Although any child can potentially be ‘at risk’ <strong>of</strong> suffering harm<br />

from maltreatment, recent research has highlighted the impact<br />

<strong>of</strong> parental difficulties such as domestic abuse, adult<br />

mental health problems <strong>and</strong> substance misuse on<br />

children’s health <strong>and</strong> development. Social isolation <strong>of</strong><br />

families can also be a factor.<br />

These research findings are important, because they<br />

mean that those <strong>of</strong> you who work primarily with<br />

adults have a responsibility to consider how the<br />

nature <strong>of</strong> their health or social problems impact<br />

on the ability to parent <strong>and</strong> to consider what this<br />

means for their children. Furthermore, we all<br />

need to be aware that risk <strong>of</strong> child maltreatment<br />

is greater for younger children <strong>and</strong> also those<br />

children who are disabled or have long-term<br />

conditions. These children are likely to have<br />

frequent contact with a range <strong>of</strong> health services.<br />

What can I do to <strong>of</strong>fer early help where<br />

there are additional needs in families<br />

It is important that services work with children<br />

<strong>and</strong> families in a ‘joined-up’ way. This<br />

could mean adult <strong>and</strong> children’s healthcare<br />

practitioners working together to provide a<br />

seamless service to a family, or it could mean<br />

working with those from other agencies <strong>and</strong> organisations, such<br />

as early years, schools, children’s social care <strong>and</strong> the voluntary<br />

sector. Involving children, young people <strong>and</strong> their families in<br />

finding solutions is empowering, helpful <strong>and</strong> productive.


The Common Assessment Framework (or ‘CAF’) was developed<br />

as part <strong>of</strong> the Every Child Matters policies <strong>of</strong> the last government<br />

to ensure that the estimated 20-30% <strong>of</strong> children who have<br />

‘additional needs’ receive timely support. ‘Additional needs’<br />

<strong>of</strong>ten include risk factors for child maltreatment, <strong>and</strong> help <strong>and</strong><br />

support at an early stage can reduce the risk <strong>of</strong> children being<br />

harmed; it may even save a child’s life.<br />

The CAF is a shared assessment <strong>and</strong><br />

planning framework that can be used<br />

across all children’s services. It aims to<br />

empower <strong>and</strong> engage families in the early<br />

identification <strong>of</strong> additional needs <strong>and</strong><br />

promote co-ordinated service provision to<br />

meet them. This process is managed by<br />

a ‘lead pr<strong>of</strong>essional’ (health pr<strong>of</strong>essionals<br />

are <strong>of</strong>ten ideally placed to take this role),<br />

will work with the family <strong>and</strong> multi-agency<br />

‘team around the child’ (a TAC). Munro<br />

recognises that there is strong support for<br />

shared thinking <strong>and</strong> assessment using a format<br />

common to all agencies <strong>and</strong> she adds that the<br />

voice <strong>of</strong> the child is crucial to this process.<br />

Working with other agencies is an important<br />

aspect <strong>of</strong> safeguarding children. Local<br />

<strong>Safeguarding</strong> <strong>Children</strong> Boards (LSCB) bring<br />

together leads from agencies <strong>and</strong> organisations<br />

who work with children <strong>and</strong> families <strong>and</strong><br />

provide strategic leadership <strong>and</strong> monitoring <strong>of</strong><br />

safeguarding children activity. In partnership with<br />

the <strong>Isle</strong> <strong>of</strong> <strong>Wight</strong> <strong>and</strong> <strong>Hampshire</strong>, Portsmouth <strong>and</strong><br />

Southampton LSCBs also provide procedural<br />

guidance to underpin local inter-agency working to safeguard<br />

<strong>and</strong> protect children 8 .<br />

8<br />

http://www.4lscb.org.uk/


Would I recognise child maltreatment<br />

In our experience, practitioners <strong>and</strong> others working in the<br />

health service are both well placed, <strong>and</strong> well able, to recognise<br />

children <strong>and</strong> young people who are at risk <strong>of</strong>, or suffering from<br />

child maltreatment. There is a wealth <strong>of</strong> research <strong>and</strong> literature<br />

in the field that helps with the identification <strong>of</strong> child abuse<br />

<strong>and</strong> neglect; <strong>and</strong> many <strong>of</strong> you will be aware <strong>of</strong> the ‘signs <strong>and</strong><br />

symptoms’. We strongly commend the National Institute for<br />

Health <strong>and</strong> Clinical Excellence (NICE) clinical guidance on child<br />

maltreatment 9 .<br />

9<br />

National Institute for Health <strong>and</strong> Clinical Excellence (2009) When to<br />

suspect child maltreatment: Clinical Guideline 89. London, NICE


In addition to outlining the key health indicators <strong>of</strong> physical <strong>and</strong><br />

sexual abuse, neglect <strong>and</strong> emotional abuse, the document also<br />

provides information on when to consider or suspect fabricated<br />

or induced illness <strong>and</strong> concludes with a useful section on harmful<br />

parent-child interactions.<br />

However, there are recognised <strong>and</strong> important barriers to<br />

recognising <strong>and</strong> responding to child maltreatment. These have<br />

been usefully summarised in a recent document from the Royal<br />

College <strong>of</strong> General Practitioners/NSPCC 10 .<br />

Their summary highlights some <strong>of</strong> the barriers already<br />

mentioned in this h<strong>and</strong>book; such as the hidden nature <strong>of</strong> harm,<br />

the tendency for the child’s needs to be overshadowed by those<br />

<strong>of</strong> the parents <strong>and</strong> the difficulties in taking an objective view.<br />

In addition, it also mentions the impact <strong>of</strong> the upsetting nature<br />

<strong>of</strong> child abuse, the feelings <strong>of</strong> a betrayal <strong>of</strong> the trust held in<br />

therapeutic relationships with the family <strong>and</strong> the practicalities<br />

<strong>and</strong> challenges <strong>of</strong> inter-agency working. Those <strong>of</strong> you who have<br />

been at the forefront <strong>of</strong> a child protection referral will recognise<br />

the difficulties <strong>and</strong> challenges, as well as the personal impact.<br />

10<br />

RCGP, NSPCC (2009) <strong>Safeguarding</strong> <strong>Children</strong> <strong>and</strong> Young People in<br />

General Practice: A Toolkit


How can I ensure that my safeguarding children<br />

practice is sound<br />

Good practice in safeguarding children reflects the importance<br />

<strong>of</strong> child-centred assessment, keeping clear <strong>and</strong> contemporaneous<br />

records in which you record your observations <strong>and</strong> what you<br />

have been told, by whom, <strong>and</strong> when <strong>and</strong> why this is <strong>of</strong> concern.<br />

We do not expect all practitioners to be experts on ‘signs <strong>and</strong><br />

symptoms’ <strong>of</strong> child abuse <strong>and</strong> neglect, but we do expect you to<br />

seek advice <strong>and</strong> support when you are worried about a child.<br />

In many cases reviewing your concerns, together with child <strong>and</strong><br />

family information that may be known by other pr<strong>of</strong>essionals,<br />

will help to build a fuller picture that can more accurately<br />

determine whether or not a child is at risk <strong>of</strong> harm.<br />

An underst<strong>and</strong>ing <strong>of</strong> the context <strong>of</strong> normal child care <strong>and</strong><br />

development is particularly helpful.<br />

It is also important that you keep up to date with safeguarding<br />

children through learning <strong>and</strong> development activities. Drawing<br />

on national guidance <strong>and</strong> recommendations from the Royal<br />

Colleges <strong>and</strong> Department <strong>of</strong> Health 11 , we have a learning <strong>and</strong><br />

development strategy that outlines the level <strong>of</strong> training required<br />

by each member <strong>of</strong> staff <strong>and</strong> the frequency with which you are<br />

expected to update your knowledge.<br />

11<br />

Royal College <strong>of</strong> Paediatrics <strong>and</strong> Child Health et al. (2010)<br />

Intercollegiate Document <strong>Safeguarding</strong> <strong>and</strong> Protecting <strong>Children</strong><br />

<strong>and</strong> Young people: roles <strong>and</strong> competences for health care staff.<br />

London: RCPCH


Importantly, we recognise that practitioners may<br />

choose to attend in-house <strong>and</strong> interagency<br />

‘training sessions’<br />

or achieve<br />

the learning<br />

outcomes<br />

through<br />

other means,<br />

such as<br />

e-learning,<br />

conference<br />

attendance,<br />

higher<br />

education<br />

programmes<br />

or self-directed<br />

study.<br />

However, all<br />

learning should<br />

be recorded in<br />

your portfolio,<br />

monitored at your<br />

personal development<br />

review as well as<br />

recorded centrally<br />

with the learning<br />

<strong>and</strong> development<br />

department to ensure<br />

compliance with<br />

m<strong>and</strong>atory requirements.<br />

The following table will<br />

help you to plan your<br />

safeguarding learning.


The Learning & Development Framework<br />

Target Group as per Working<br />

Together (p.125-131)<br />

Key Learning outcomes<br />

Group 1<br />

Staff with infrequent contact<br />

with children, young people<br />

<strong>and</strong>/or parents/carers who may<br />

become aware <strong>of</strong> possible abuse<br />

or neglect e.g. receptionists,<br />

administrative <strong>and</strong> facilities staff<br />

(i.e. non-clinical staff)<br />

• Define child abuse <strong>and</strong><br />

neglect<br />

• Recognise key indicators <strong>of</strong><br />

concern<br />

• Appreciate normal child<br />

development<br />

• Maintain a child focus<br />

• Know what to do if<br />

concerned about a child<br />

Group 2<br />

All clinical staff who have any<br />

contact with children, young<br />

people <strong>and</strong>/or parents/carers i.e.<br />

all clinical staff who are not in<br />

Group 3<br />

As above, plus:<br />

• Documentation <strong>and</strong><br />

sharing <strong>of</strong> concerns<br />

• CAF/Framework for<br />

Assessment<br />

• Own safeguarding roles<br />

<strong>and</strong> responsibilities


Methods <strong>of</strong> delivery<br />

Delivered by<br />

Benchmark with<br />

Intercollegiate<br />

Document (RCPCH<br />

et al., 2010)<br />

New staff:<br />

All new staff to receive<br />

‘<strong>Safeguarding</strong> <strong>Children</strong><br />

Basic Awareness’ session on<br />

Corporate Induction (1 hour)<br />

Existing staff:<br />

All staff will receive an<br />

update/refresher on Essential<br />

Training Update (ETU)<br />

<strong>Safeguarding</strong> <strong>Children</strong><br />

element delivered 3 yearly<br />

<strong>Safeguarding</strong><br />

<strong>Children</strong> Team<br />

<strong>Safeguarding</strong><br />

<strong>Children</strong> Team<br />

Level One<br />

New Staff:<br />

All new staff in Group 2<br />

will attend a ‘<strong>Safeguarding</strong><br />

<strong>Children</strong> for Health<br />

Pr<strong>of</strong>essionals’ following<br />

Corporate Induction<br />

Existing Staff:<br />

All Group 2 staff will access a<br />

refresher at least every three<br />

years<br />

Staff may also attend relevant<br />

Inter-agency Integrated<br />

Working & <strong>Safeguarding</strong><br />

training provided by both<br />

Portsmouth & Southampton’s<br />

<strong>Children</strong>’s Trusts<br />

Various within<br />

programme<br />

Level Two


The Learning & Development Framework<br />

Target Group as per Working<br />

Together (p.125-131)<br />

Key Learning outcomes<br />

Group 3<br />

Clinical staff who work<br />

predominately with children,<br />

young people <strong>and</strong>/or their<br />

parents/carers e.g. GPs, urgent<br />

<strong>and</strong> unscheduled care staff,<br />

mental health staff, learning<br />

disability staff, substance misuse<br />

staff, paediatric allied health<br />

pr<strong>of</strong>essionals, sexual health<br />

staff, school nurses, health<br />

visitors, children’s community<br />

nurses, CAMHS <strong>and</strong> paediatric<br />

dentists<br />

As above, plus<br />

• Working together to<br />

identify <strong>and</strong> assess the<br />

needs <strong>of</strong> children where<br />

there are safeguarding<br />

issues<br />

• Impact <strong>of</strong> parenting<br />

issues such as substance<br />

misuse, domestic abuse<br />

• Recognising the<br />

importance <strong>of</strong> family<br />

history <strong>and</strong> functioning<br />

• Working with children<br />

<strong>and</strong> family members,<br />

including addressing lack<br />

<strong>of</strong> co-operation <strong>and</strong><br />

superficial compliance<br />

Group 4<br />

<strong>Safeguarding</strong> leads<br />

Specialist Practitioners<br />

As above, plus<br />

• Supporting S.47 enquiries,<br />

roles <strong>and</strong> responsibilities<br />

• Using pr<strong>of</strong>essional<br />

judgement<br />

• Taking emergency action<br />

• Working with complexity<br />

• Communicating with<br />

children<br />

• Supervising <strong>and</strong><br />

supporting staff


Methods <strong>of</strong> delivery<br />

Delivered by<br />

Benchmark with<br />

Intercollegiate<br />

Document (RCPCH<br />

et al., 2010)<br />

Inter-agency training (via<br />

LSCB/<strong>Children</strong>’s Trust) specific<br />

to staff in Group 3 <strong>and</strong><br />

Service-specific/bespoke<br />

training<br />

Refresher at least every<br />

three years<br />

Various via<br />

Interagency<br />

programme<br />

Solent<br />

<strong>Safeguarding</strong><br />

<strong>Children</strong> Team<br />

Level<br />

Three<br />

Inter-agency training.<br />

Service-specific/bespoke<br />

training<br />

Pr<strong>of</strong>essional development<br />

activities.<br />

Refresher at least every<br />

three years<br />

Level Three/Four


The Learning & Development Framework<br />

Target Group as per Working<br />

Together (p.125-131)<br />

Key Learning outcomes<br />

Group 5/6<br />

Named Pr<strong>of</strong>essionals<br />

Designated/Consultant<br />

Pr<strong>of</strong>essionals<br />

Operational managers <strong>of</strong><br />

children’s services<br />

As above, plus<br />

• Promoting effective<br />

practice<br />

• Effecting change<br />

• Managing performance<br />

Group 7<br />

Strategic managers<br />

Board members<br />

As per content for Groups1-3,<br />

plus<br />

Section 11 responsibilities<br />

Group 8<br />

LSCB members<br />

As per content 1-3, plus<br />

Expectations <strong>of</strong> members<br />

Current Policy, research <strong>and</strong><br />

practice developments<br />

Lessons from Serious Case<br />

Reviews


Methods <strong>of</strong> delivery<br />

Delivered by<br />

Benchmark with<br />

Intercollegiate<br />

Document (RCPCH<br />

et al., 2010)<br />

Education, training <strong>and</strong><br />

learning in a three year<br />

period (including leadership,<br />

management, appraisal <strong>and</strong><br />

supervision training)<br />

Designated pr<strong>of</strong>essionals:<br />

As above, plus<br />

Participate in local, regional<br />

<strong>and</strong> national events<br />

Refresher at least every<br />

three years<br />

Various via<br />

Interagency<br />

programme<br />

Solent<br />

<strong>Safeguarding</strong><br />

<strong>Children</strong> Team<br />

Level<br />

Three<br />

Briefing events<br />

LSCB Induction Programme<br />

Self-directed learning<br />

Refresher at least every<br />

three years<br />

N/A<br />

LSCB Induction Programme<br />

LSCB Development Days<br />

National Leadership<br />

Programme<br />

Refresher at least every<br />

three years


What do I do if I am worried about a child<br />

Concerns about the safety <strong>and</strong> welfare <strong>of</strong> a child or young<br />

person should always be shared. In this respect it is important to<br />

avoid making a promise <strong>of</strong> confidentiality to a child. If you are<br />

worried about the well-being <strong>of</strong> a child you should first speak to<br />

your manager or a senior practitioner.<br />

You can also contact designated <strong>and</strong> named health<br />

pr<strong>of</strong>essionals <strong>and</strong> their teams (details are provided<br />

at the end <strong>of</strong> this h<strong>and</strong>book).<br />

If concerns remain, further<br />

discussion can also take place<br />

with <strong>Children</strong>’s Social Care or the<br />

Police, who should be the first<br />

point <strong>of</strong> contact in an emergency.<br />

A decision may be made to make<br />

a formal referral to <strong>Children</strong>’s<br />

Social Care.<br />

Health pr<strong>of</strong>essionals are expected<br />

to contribute their expertise to the<br />

assessment <strong>and</strong> planning for the<br />

child’s safety <strong>and</strong> should be clear in<br />

detailing their concerns <strong>and</strong> the reason<br />

for referral.<br />

The SAFER tool, designed for use by<br />

health visitors, but applicable to other<br />

health pr<strong>of</strong>essionals is helpful in this<br />

respect 12 . Telephone referrals to <strong>Children</strong>s Social Care should be<br />

followed up in writing, within 48 hours, using an Inter-Agency<br />

Referral form. <strong>Children</strong>’s Social Care operates an ‘Emergency<br />

Duty Service’ outside <strong>of</strong> <strong>of</strong>fice hours.<br />

12<br />

http://www.unitetheunion.org/pdf/NHS%20Safer%20tools.pdf


<strong>Children</strong>’s Social Care may decide<br />

to convene an early ‘strategy discussion’, normally involving<br />

the referring agency <strong>and</strong> the police. Further enquiries may take<br />

place prior to a multi-agency Child Protection Conference, which<br />

may result in putting in place a ‘Child Protection Plan’ to address<br />

concerns <strong>of</strong> risk <strong>of</strong> harm.<br />

Health pr<strong>of</strong>essionals play a crucial role in contributing to child<br />

protection (or ‘s47’) enquiries <strong>and</strong> Child Protection Conferences.<br />

This will include the provision <strong>of</strong> a written report, which will<br />

normally be shared with parents in advance <strong>of</strong> the Conference.<br />

The 4LSCB <strong>Safeguarding</strong> <strong>Children</strong> Procedures provide guidance<br />

on referral <strong>and</strong> response in line with Working Together.<br />

If you are worried about a child, it is crucially important to be<br />

open <strong>and</strong> honest with parents, <strong>and</strong> where age-appropriate the<br />

child or young person, as to the nature <strong>of</strong> your concerns <strong>and</strong> the<br />

need to involve other agencies, unless to do so would place the<br />

child or others at greater risk.<br />

The vast majority <strong>of</strong> children who are subject to a Child<br />

Protection Plan will remain in the family home, <strong>and</strong> parents<br />

have the key role <strong>and</strong> responsibility for ensuring their future<br />

protection from harm.


How do I ensure that I share information<br />

appropriately<br />

There are now excellent guidelines available to help you<br />

to underst<strong>and</strong> when you should, <strong>and</strong> should not, share<br />

information 13 . The guidelines include the seven ‘Golden Rules’<br />

for information sharing.<br />

We have included these rules<br />

in this h<strong>and</strong>book because <strong>of</strong><br />

their importance in practice.<br />

Where possible seek<br />

consent if you wish to share<br />

information. However, the<br />

notion <strong>of</strong> ‘public interest’<br />

means that you can share<br />

information without<br />

consent if you make a<br />

balanced pr<strong>of</strong>essional<br />

judgement that this is<br />

necessary to protect an<br />

individual, promote<br />

their well-being or<br />

prevent a crime.<br />

13<br />

This can be downloaded as a ‘pocket guide’ http://www.dcsf.gov.uk/<br />

everychildmatters/resources-<strong>and</strong>-practice/IG00340/


The seven ‘Golden Rules’ <strong>of</strong> information sharing<br />

1. Remember that the Data Protection Act is not a barrier<br />

to sharing information but provides a framework to<br />

ensure that personal information about living persons<br />

is shared appropriately.<br />

2. Be open <strong>and</strong> honest with the person (<strong>and</strong>/or their family<br />

where appropriate) from the outset about why, what, how<br />

<strong>and</strong> with whom information will, or could be shared, <strong>and</strong><br />

seek their agreement, unless it is unsafe or inappropriate<br />

to do so.<br />

3. Seek advice if you are in any doubt, without disclosing<br />

the identity <strong>of</strong> the person where possible.<br />

4. Share with consent where appropriate <strong>and</strong>, where<br />

possible, respect the wishes <strong>of</strong> those who do not consent<br />

to share confidential information. You may still share<br />

information without consent if, in your judgement, that<br />

lack <strong>of</strong> consent can be overridden in the public interest.<br />

You will need to base your judgement on the facts<br />

<strong>of</strong> the case.<br />

5. Consider safety <strong>and</strong> well-being: Base your information<br />

sharing decisions on considerations <strong>of</strong> the safety <strong>and</strong><br />

well-being <strong>of</strong> the person <strong>and</strong> others who may be affected<br />

by their actions.<br />

6. Necessary, proportionate, relevant, accurate, timely <strong>and</strong><br />

secure: Ensure that the information you share is necessary<br />

for the purpose for which you are sharing it, is shared<br />

only with those people who need to have it, is accurate <strong>and</strong><br />

up-to-date, is shared in a timely fashion, <strong>and</strong> is shared<br />

securely.<br />

7. Keep a record <strong>of</strong> your decision <strong>and</strong> the reasons for it -<br />

whether it is to share information or not. If you decide<br />

to share, then record what you have shared, with whom<br />

<strong>and</strong> for what purpose.


How can clinical supervision help<br />

Clinical supervision plays an important role in providing support<br />

<strong>and</strong> developing expertise in safeguarding children practice. It<br />

can serve to address some <strong>of</strong> the barriers <strong>and</strong> ensure a<br />

child-centric approach.<br />

We advocate that clinical supervision is ‘action-oriented’ <strong>and</strong><br />

that each session begins with a review <strong>and</strong> evaluation <strong>of</strong> actions<br />

from the previous meeting.<br />

Where a child is known to be at risk, clinical supervision provides<br />

a key opportunity to review the progress <strong>of</strong> child protection<br />

plans <strong>and</strong> to address any continuing or emergent concerns.<br />

All practitioners should have regular<br />

clinical supervision in<br />

accordance<br />

with the local<br />

policy. An overarching<br />

message<br />

for making<br />

safeguarding<br />

children ‘Everyone’s<br />

responsibility’ is that<br />

you should not act in<br />

isolation.<br />

We end by providing<br />

details <strong>of</strong> the<br />

pr<strong>of</strong>essional support<br />

available to you <strong>and</strong><br />

contact details for<br />

statutory agencies.


What happens if<br />

my concerns are not<br />

taken seriously<br />

Because we underst<strong>and</strong><br />

how difficult it can be<br />

for a practitioner to<br />

consider or suspect child<br />

maltreatment, we always<br />

take such concerns seriously.<br />

However, we do know<br />

that sometimes it can be<br />

challenging to ensure that<br />

there is a proportionate<br />

response. Your skills in<br />

assessment, communication <strong>and</strong><br />

documentation will help<br />

others to underst<strong>and</strong> what<br />

the concerns are, <strong>and</strong> help<br />

to ensure the best outcome<br />

for the child.<br />

Written communication, that sets out clearly the concerns, risk<br />

factors <strong>and</strong> any protective factors within the family is crucial to<br />

ensuring a helpful response.<br />

However, if the response from your manager, senior practitioner,<br />

safeguarding pr<strong>of</strong>essional or statutory agency leaves you<br />

with continuing concerns then it is important that these are<br />

‘escalated’ to those with more seniority. We would be very<br />

happy to help you <strong>and</strong>/or your manager to achieve this.


How can I get help<br />

<strong>Safeguarding</strong> <strong>Children</strong> <strong>of</strong>fices<br />

Solent East (Portsmouth) 023 9281 6740<br />

Solent West (Southampton) 023 8071 6671<br />

Supported by <strong>Safeguarding</strong> <strong>Children</strong> administrators, the <strong>of</strong>fices<br />

are staffed by Consultant (Designated) Nurses, Named Nurses<br />

<strong>and</strong> Specialist Practitioners.<br />

The key roles <strong>of</strong> these pr<strong>of</strong>essionals include statutory<br />

responsibilities for supporting <strong>and</strong> developing safeguarding<br />

children practice through partnership working with other<br />

key agencies. The teams <strong>of</strong>fer clinical supervision, advice <strong>and</strong><br />

support to health practitioners; this can range from a discussion<br />

<strong>of</strong> the nature <strong>of</strong> concerns about a child to support with<br />

procedural aspects <strong>of</strong> safeguarding.<br />

They also play a significant role in supporting your learning <strong>and</strong><br />

development in this field.<br />

Child Protection Medical Helpline<br />

Solent East 023 9247 2948<br />

Solent West 023 8071 6629<br />

Under the leadership <strong>of</strong> the Designated <strong>and</strong> Named Doctors,<br />

the community paediatric medical team provide advice <strong>and</strong><br />

undertake child protection medicals as required.


Other key contacts:<br />

Portsmouth <strong>Children</strong>’s Social Care 023 9283 9111<br />

Emergency Duty Service 0845 600 4555<br />

Southampton <strong>Children</strong>’s Social Care 023 8083 3336<br />

Emergency Duty Service 023 80233344<br />

Police 0845 0454545<br />

Portsmouth Hospitals NHS Trust 023 9228 6000<br />

<strong>Safeguarding</strong> Office: Ext 4312/4314<br />

Southampton University Hospitals 023 8079 8409<br />

NHS Trust <strong>Safeguarding</strong> Office<br />

South East <strong>Hampshire</strong> 023 9268 3802<br />

<strong>Safeguarding</strong> Office<br />

‘It is important for pr<strong>of</strong>essionals to trust their feelings<br />

when they perceive children to be suffering, <strong>and</strong> not<br />

make assumptions that others have also perceived it <strong>and</strong><br />

are better placed to act.<br />

It is simpler to lift the telephone than to live with the<br />

regret <strong>of</strong> not having done so.’<br />

Serious Case Review Executive Summary: Baby Peter<br />

(February, 2009)


Could this be child maltreatment<br />

• A District Nurse finds an eight year-old providing the<br />

overnight care <strong>of</strong> her gr<strong>and</strong>father.<br />

• A three year-old with speech <strong>and</strong> language delay has<br />

missed three appointments with the therapist.<br />

• A four month-old infant was noted to have bruising<br />

on his cheek.<br />

• A health pr<strong>of</strong>essional telephoning to change an<br />

appointment was told by a six year-old ‘Mummy’s not here’.<br />

• A 13 year-old disclosed that she thought she might be<br />

pregnant.<br />

• A toddler presents in clinic with small burns on each h<strong>and</strong>.<br />

• On a hot day a child is noted to be somewhat ‘overdressed’.<br />

• A client’s child always seems to be there when you call.<br />

• The parents <strong>of</strong> a child with a life-limiting illness have<br />

rejected conventional medicine <strong>and</strong> are treating her with<br />

homeopathy.<br />

• An expectant mother is smoking small quantities <strong>of</strong><br />

cannabis.<br />

What else would you need to know In all these cases further<br />

information needs to be gathered. The focus <strong>of</strong> decisionmaking,<br />

however, must always be on the impact on, <strong>and</strong><br />

perspective <strong>of</strong>, the child.


Tell us about it<br />

We are always trying to improve our service <strong>and</strong> welcome any suggestions,<br />

comments or complaints. In the first instance please bring them to the<br />

attention <strong>of</strong> the Service Manager on 023 9281 6740. Alternatively speak<br />

or write to our Patient Experience Service (PES). You can also pass on your<br />

comments via our website.<br />

Patient Experience Service<br />

PES support line: 0800 0132 319<br />

Email: soc-pct.SCHpatientexperience@nhs.net<br />

Website: www.solent.nhs.uk/about/pes<br />

Dr Catherine Powell<br />

Consultant Nurse <strong>Safeguarding</strong> <strong>Children</strong><br />

Somerstown Health Centre<br />

Blackfriars Close<br />

Southsea<br />

PO5 4NJ<br />

Production No<br />

04_2011_111<br />

Publication date 04_2011<br />

Review date 04_2012<br />

Produced by BAREFOOTdesign in association with ©Solent NHS Trust

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