Reference Manual for Managers Final 06 03 09 by 9GcfzY8

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									                         March 2009

    CHILD PROTECTION AND WELLBEING
NHSGGC REFERENCE MANUAL FOR MANAGERS



 Lead Manager:           Marie Valente

 Responsible Director:   CH (C) P Directors, Directors of Acute Divisions

 Approved by:            NHSGGC Child Protection Forum

 Date approved:          21st January 2009

 Date for Review:        21st January 2012




                                  1
CONTENTS                                              PAGE

Executive summary                                         3
Introduction                                              5
What Young People Say                                     5
National Policy Background                                7
National Inquires                                        12
Legislative Background                                   12
Roles and responsibilities of NHSGGC staff               13
Key definitions and concepts                             20
Recognition                                              21
What to do if you are worried about a child              28
Tripartite discussions                                   28
Paediatric Medical Examinations                          30
Adolescent paediatric and forensic medicals              31
Sharing of information                                   32
Early sharing and collation of information               33
Training                                                 34
Key contributors                                         34
Consultation process                                     34


APPENDICES

Appendix 1      -   GIRFEC diagram
Appendix 2      -   Assessment triangle
Appendix 3      -   Organisational chart
Appendix 4      -   Child Protection Unit leaflet
Appendix 5     -    Staff Leaflet (Salary slips)
Appendix 6     -    Social Work Contacts
Appendix 7     -    NHS Contacts
Appendix 8     -    Shared Referral Form
Appendix 9     -    Tripartite Discussions Diagram
Appendix 10    -    Early Sharing and Collation of Information
                    Forms
Appendix 11     -   List of other related policies, procedures
                    and guidance
Appendix 12    -    References




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Executive Summary
This handbook sets out NHSGGC’s staff roles and responsibilities with regard to ensuring
child protection and wellbeing. It aims to ensure that staff know how to act should they
have concerns. It offers guidance on key aspects of child protection and wellbeing that are
particularly relevant to health staff.

It describes NHSGGC’s vision for children. The overall purpose of NHSGGC is to deliver
effective and high quality health services, act to improve the health of our population and
reduce health inequalities. These key objectives are detailed in the children’s service
planning process.

It highlights key messages from young people. Some of these are:

            Relating to, listening to, communication with young people, personality of
             staff
            Respect their views / feelings
            Give time/space
            Confidentiality
            Make sure they know they are loved and protected
            Remove from harm
            Work together
            Ongoing support
            Use child friendly language
            Tell them not their fault

It outlines the national policy background pertaining to child protection and wellbeing, and
extracts key messages for NHSGGC. The main messages from the following documents
are elucidated:

            It’s Everyone’s Job to Make Sure I’m alright ,Scottish Executive, 2002
            Protecting Children and Young People: The Framework for Standards,
             Scottish Executive, 2004a
            Protecting Children and Young People: The Charter, Scottish Executive,
             2004b
            Protecting Children and Young People, Child Protection Committees,
             Scottish Executive, 2005
            How Well Are Children and Young People Protected and Their Needs Met?:
             Self Evaluation Using Quality Indicators, HMIE, 2005
            Evaluation of Services for Children and Young People: Generic Quality
             Indicators, HMIE, 2006
            Getting It Right for Every Child: Proposals for Action, Scottish Executive,
             2006a
            Delivering a Healthy Future: An Action Framework for Children and Young
             People’s Health in Scotland, Scottish Executive, 2006b
            Have we got our priorities right? Children living with parental substance use,
             Aberlour, 2006


                                              3
             Hidden Harm – next Steps: Supporting Children- Working with parents,
              Scottish Executive, 2006c
             Emergency Care Framework For Children and Young People in Scotland,
              Scottish Executive, 2006d
             Guide to Evaluating Services for Children and Young People Using Quality
              Indictors” (2007) HMIE
             Better Health, Better Care Action Plan, Scottish Government, 2007

It highlights the legislative background pertinent to child protection and wellbeing work,
extracting relevant aspects of The Children Scotland Act (1995)

The following key concepts in child protection and wellbeing work are described and
defined:

             Definition of a child
             Child Abuse
             Child neglect
             Child in need
             Significant Harm
             Child protection

It offers guidance on recognition of key signs of possible child abuse.

Information on paediatric/forensic medicals is provided.

Guidance on sharing of information is provided. General principles are highlighted as
follows:

             All staff have a responsibility to act to make sure that all children are
              protected from harm
             Appropriate care is dependent on those providing that care having ready
              access to relevant information
             If there is reasonable concern that a child may be at risk of significant harm
              this will “always override a professional or agency requirement to keep the
              information confidential” CMPO (2004)19

The main tenets of the early sharing and collation of information system are described.
The Child Protection Unit acts as a “one stop shop” for social workers at the initial stage of
information gathering following a child protection concern being raised. On receipt of a
telephone enquiry administrative staff access health databases and where necessary,
other available information in relation to an identified child or children. It is currently
possible to access health data from a variety of sources available within the Unit, and this
information can be made available very quickly. Information being sourced outwith the unit
takes longer but in most cases it should be possible to provide social work, police and
health colleagues with a list of health services together with names and contact details of
key individuals who have been involved with the child, within the same working day. A
summary of key information contained in the directly accessible data sources is also
provided. The information collated is reviewed by the Advisor on duty prior to sharing.

The importance of training is emphasized. All staff should be trained in child welfare and
protection to ensure competency in the discharge of their duties. A framework for

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standards in this area is set out in the NHSGGC strategic Training Plan 2007. A training
calendar of courses is produced regularly by the Child Protection Unit.




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1.     Introduction

1.1.   NHSGGC vision for children’s services

1.1.1. NHSGGC seeks to embrace the Scottish Government’s vision for children- that they
       are safe, healthy, active, nurtured, achieving included, respected and responsible.

1.1.2. Our overall purpose in NHSGGC is to deliver effective and high quality health
       services, act to improve the health of our population and reduce health inequalities.
       These key objectives are detailed in the children’s service planning process. Overall
       objectives for NHSGGC are:

            Improve resource utilization
            Shift the balance of care
            Focus resources on greatest need
            Improve accessibility
            Modernise services
            Improve health
            An effective organisation.

1.1.3. So our vision is to make sure that we manage our resources effectively to protect
       children and young people and ensure that their needs are met.

1.3.   Purpose of this policy and procedural guidance and who it is for

1.3.1. This policy and procedural guidance is for all NHSGGC managers Its purpose is to
       offer guidance on key aspects of child protection and wellbeing work that are
       particularly relevant to health staff.


2.     What Young People Say
2.1    Recent developments from the Scottish Government and HMIe (Children’s Charter
       and Quality Indicators) have highlighted the importance of seeking the views of and
       listening to children and young people. This work has helped strengthen the resolve
       of organisations to focus more strongly on seeking the views of children and young
       people in respect of services provided.

2.2.   NHSGGC Child Protection Unit consulted with young people (Youth Voices and
       Young Scot) upon what should be included in child protection training for staff. The
       results are indicative of what young people feel is important in child protection /
       wellbeing work. Young people reported the following as significant:

            Relating to, listening to, communication with young people, personality of
             staff
            Example - Being fun, caring, calm, don’t treat like babies, listen to them, give
             good advice, be sensitive
            Respect their views / feelings
            Example - Respect them as individuals, they’ll get upset easy

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            Give time/space
            Example - Be patient, don’t touch them if scared, don’t pressurise them
            Confidentiality
            Example - Should be able to tell in confidence unless life threatening
            Frequency of training
            Example - They should be updated, it is very important
            Make sure they know they are loved and protected
            Example - People want to help, tell them they are loved
            Telling
            Example - Sometimes it is hard to tell, tell them they should tell
            Remove from harm.
            Example - Protect them from getting harmed, in a modern society children
             have the right to a loving family
            Work together
            Example - No one is perfect but if we work together
            Ongoing support
            Example - Child Line, don’t leave them
            Use child friendly language
            Example - No jargon
            Tell not their fault
            Example - They haven’t brought it on themselves.

2.3.   Young people felt that the following were important messages for staff:

            Relating to, listening to, communication with young people, personality of
             staff
            Example - Know about children, listen to them, don’t guess, be kind, don’t
             talk down to them, might not want to talk to someone the same sex as the
             person that hurt them
            Respect their views / feelings
            Example - Some children might be cheeky / aggressive because of it, take a
             step in the child’s shoes
            History
            Example - Should know their history, family, friends, the story of what
             happened
            Give time/space
            Example - Take time to get to know you, don’t rush them, let them get to
             know you


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            Protect them
            Example - Teach them to protect self, put safe adults in playgrounds
            Helpline
            Example - Special support number for children, Childline.
            Blame
            Example - Children can blame themselves
            Ongoing support
            Example - Fun things to do
            Children with disabilities
            Example - Like autism, need to be careful
            Telling
            Example - Understand how hard it is to tell
            Other
            Example - Not sure.

3.     National Policy Background
3.1.   The key policies that inform NHSGGC child protection work are:

            It’s Everyone’s Job to Make Sure I’m alright ,Scottish Executive, 2002
            Protecting Children and Young People: The Framework for Standards,
             Scottish Executive, 2004a
            Protecting Children and Young People: The Charter, Scottish Executive,
             2004b
            Protecting Children and Young People, Child Protection Committees,
             Scottish Executive, 2005b
            How Well Are Children and Young People Protected and Their Needs Met?:
             Self Evaluation Using Quality Indicators, HMIE, 2005
            Evaluation of Services for Children and Young People: Generic Quality
             Indicators, HMIE, 2006
            Getting It Right for Every Child: Proposals for Action, Scottish Executive,
             2006
            Delivering a Healthy Future: An Action Framework for Children and Young
             People’s Health in Scotland, Scottish Executive, 2006
            Have we got our priorities right? Children living with parental substance use,
             Aberlour, 2006
            Hidden Harm – next Steps: Supporting Children- Working with parents,
             Scottish Executive, 2006
            Emergency Care Framework For Children and Young People in Scotland,
             Scottish Executive, 2006
            Guide to Evaluating Services for Children and Young People Using Quality
             Indictors” (2007) HMIE
            Better Health, Better Care Action Plan, Scottish Government, 2007.


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3.2.    It’s Everyone’s Job to Make Sure I’m alright, Scottish Executive, 2002 is the report
       of the national audit and review of child protection services. The review audited the
       child protection practice of police, medical, nursing, social work, Scottish Children’s
       Reporter Administration and education staff. Some of its main findings were as
       follows:

             Evidence of real progress and improvement during last 20 years although not
              always measurable
             Clear evidence of many children living in conditions and under threats that
              are not tolerable in a civilised society
             Children, their parents and some professionals do not have confidence in the
              system
             Children and their families do not always get the help they need when they
              need it
             Neglect is a major cause for concern.

       The report made 17 recommendations for actions placed within a three year time
       frame.

3.3    Protecting Children and Young People: The Framework for Standards, Scottish
       Executive, 2004 sets out the following broad standards for child protection services
       nationally:

             Children get the help they need when they need it
             Professionals take timely and effective action to protect children
             Children are listened to and respected
             Agencies and professionals share information about children where this is
              necessary to protect them
             Agencies and professionals work together to assess needs and risks and
              develop effective plans
             Professionals are confident and competent
             Agencies work in partnership with members of the community to protect
              children
             Agencies, individually and collectively, demonstrate leadership and
              accountability for their work and its effectiveness.

3.4.   Children’s Charter (Scottish Executive 2004)) indicates that children have stated
       that they want the system to do the following:

             Get to know us
             Speak with us
             Listen to us
             Take us seriously
             Involve us
             Respect our privacy
             Be responsible to us
             Think about our lives as a whole
             Think carefully about how you use information about us
             Put us in touch with the right people
             Use your power to help
             Make things happen when they should
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             Help us to be safe.

3.5.   Child Protection Committees, Scottish Executive, 2005 makes clear the
       expectations of key agencies and their senior officials with respect to the protection
       of children. It also sets out in detail what is expected of Child Protection
       Committees themselves. The expected key outcomes from the guidance are:

             Greater strategic leadership and ownership of activity to protect children and
              young people
             Improved co-operation between agencies at a local area in their work to
              protect children
             Clearer understanding of the functions of Child Protection Committees and
              the key tasks that they should undertake in order to fulfil those functions
             Better connectedness and contribution of Child Protection Committees both
              to the development and delivery of local services and, in sharing good
              practice, to child protection across Scotland.

3.6.   How Well Are Children and Young People Protected and Their Needs Met?: Self
       Evaluation Using Quality Indicators, HMIE, 2005 contains five high level questions
       framing inspections. These are:

             How effective is the help children and young people get when they need it?
             How effectively do agencies and the community work together to keep
              children and young people safe?
             How good is the delivery of key processes?
             How good is operational management in protecting children and meeting
              their needs?
             How good is individual and collective strategic leadership?

3.7.   Evaluation of Services for Children and Young People: Generic Quality Indicators,
       HMIE, 2006 focuses on developing an outcome-focused, intelligence-led and
       proportionate framework for evaluating children’s services. A set of generic quality
       indicators have been developed for use in self-evaluation and inspection.
       Organisations are asked to answer six high-level questions. Generic key areas are
       linked with each high-level question. These high level questions are:

             What key outcomes have we achieved?
             How well do we meet the needs of our stakeholders?
             How good is our delivery of services for children and young people?
             How good is our management?
             How good is our leadership?
             What is our capacity for improvement?

       The generic key areas are:

             Key performance outcomes
             Impact on users of services for children and young people
             Impact on staff
             Impact on the community
             Delivery of services for children and young people


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            Policy development and planning
            Management and support of staff
            Partnership and resources
            Leadership and direction
            What is our capacity for improvement?

3.8.   Getting It Right for Every Child (GIRFEC) (2007) aims to change practice and
       remove barriers in order to put children at the heart of all services. It promotes a
       unified approach to children’s services with a focus on outcomes for children, clear
       duties for local co-operation and co-ordination between agencies. It supports the
       use of a single integrated assessment tool, and a multi agency action plan where a
       child’s needs are complex or serious, with a lead professional to make sure this
       happens. See APPENDICES 1 and 2.

3.9.   Delivering a Healthy Future: An Action Framework for Children and Young People’s
       Health in Scotland (Scottish Executive 2007) is designed to bring together the
       challenges facing the provision of children and young peoples health services and
       the actions required from the NHS and Scotland and its partners. It sets out a
       structured programme of actions, taken largely from existing policy initiatives and
       commitments and guidance regarding those actions. It makes it clear that the
       desired outcome is support, intervention, and service delivery that meets the needs
       of current and future generations of children that are:

            Targeted to the health challenges of the 21st century
            Based on best evidence
            Designed to protect and promote health as well as treating disease
            Capable of addressing needs of children who may be vulnerable or at risk
            Centred on children, young people and their families
            Delivered consistently and equitably throughout the country.

       The report focuses on the following aspects of child health care:

            Providing care locally
            Emergency care
            Hospital services
            Specialist services
            Child and adolescent mental health
            Children with complex needs
            Remote and rural care.

       It emphasises the importance of working together and defines key elements for a
       health service fit for children and young people.

3.10. Have we got our priorities right? Children living with parental substance use,
       Aberlour, 2006 is the report of a Think Tank on the impact of parental drug and
       alcohol use on children. The Think Tank was drawn together by Aberlour from
       commissioners, managers, practitioners and researchers working in health,
       education and social work, criminal justice and drugs and alcohol services across
       Scotland. The report focuses on:-

       What is the effect of Parental Substance Misuse?

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            Characteristics of substance misuse
            Impact of parental substance use
            Key considerations for service

      When should a child be removed from home?

            Principles to guide decisions
            Key indicators for removal of children

      What are the implications for Policy and Practice?

      The Think Tank identified the following key areas for action for policy makers and
      services providers.

            Putting the child’s needs first
            A multi agency holistic approach
            Early identification
            Early intervention
            Assessment
            Listening to children
            Engagement with parents
            Develop more accessible and available services for children and parents
            The role of school as a safe environment and place of support
            The need for clear, well understood thresholds
            Training
            Develop a range of care options for children
            Develop parenting initiatives.

3.11. Hidden Harm – next Steps: Supporting Children- Working with parents, Scottish
      Executive, 2006 followed on from the publication by the Drug Advisory Council on
      the Misuse of Drugs of “Hidden Harm” in 2003 which highlighted the plight of
      children affected by parental drug use and the response by Scottish Executive in
      2004 which also included parental alcohol problems. This document identifies and
      brings together a range of actions and initiatives to improve the way in which
      agencies identify, protect and support children and young people living with parental
      substance misuse. The key actions from the report:

            Legislation to require the sharing of information amongst agencies for child
             protection purposes
            Improving contraception and family planning services for substance misusers
            Improving the way that holistic maternity services for drug using women,
             addiction services and services for children and families work together
            Presenting legislation to implement “Getting it Right for Every Child” to place
             a duty on all agencies to identify the needs of children for whom they have
             responsibility
            Early and better identification of the needs of vulnerable children and
             appropriate, integrated and timely support, through “Getting it Right for Every
             Child”


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            Establishing incentives for GP practices to put in place protocols so that
             young carers will be put in contact with local support services and support
             agencies
            Expanding the Scottish Drug Misuse Database to ensure that information on
             dependent children of drug using parents is collected when clients present
             for treatment.

3.12. Emergency Care Framework for Children and Young People of Scotland (Scottish
      Executive, 2007) describes a way forward to deliver improvements in emergency
      care and the steps that should taken over the next three years to deliver the
      improvements required. The report concentrates on:

            Caring for children and young people
            Emergency care for children and young people in Scotland – the key drivers
            Where should children and young people receive emergency care?
            Vulnerability in children and young people
            Clinical care of children and young people
            Staff competencies and training
            Active inclusion of children and young people.

3.13. This policy acknowledges the challenge of defining vulnerability in children and
      young people. It urges us to recognise that in the emergency care context some
      children may be at particular risk of injury or harm because of personal, family or
      social factors. Child protection is highlighted as a significant area of service in
      emergency care.

3.14. Self harm is emphasized as an important area of service in emergency care.
      Children and young people presenting with possible/actual self harm have complex
      needs. Their treatment is more complex than adults and there must be appropriate
      referral mechanisms in place to refer on to Child and Adolescent Mental Health
      Services.

3.15. Better Health, Better care: Action Plan, Scottish Government, 2007 sets out a
      programme of work for the next five years. It sets out the government’s single,
      overarching purpose – to focus government and public services on creating a more
      successful country, with opportunities for all of Scotland to flourish, through
      increasing sustainable economic growth.

3.16. Ensuring that children have the best possible start in life is at the forefront of the
      agenda. The following are some of the actions that the Government intends to take
      in order to achieve this:

            Develop a long term early years strategy
            Change cultures, systems and practices via GIRFEC
            Implementation of Health for All
            Work to protect children from the effects of drugs, alcohol and smoking
            Implement Looked After Children and Young People: We Can and Must do
             Better
            Develop specialist nurses for LAAC
            Strengthen ante natal care – parents with higher needs, especially teenage
             mothers
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            Promote infant nutrition
            Improve breastfeeding rates
            School based preventative dental services
            Publish reviews of current evidence on early interventions
            Extend entitlement to free school meals
            Extend healthcare support for schools – start in areas with highest
             concentration of vulnerable children
            Implement the Mental Health of Children and Young People Framework
            Publish a national delivery plan for specialist children’s services
            Sustain four major children’s hospitals across Scotland.

3.17. Guide to Evaluating Services for Children and Young People Using Quality
      Indictors” (2007) HMIE promotes consistent delivery of better integrated services for
      children and young people and indicates that this requires a coherent approach to
      quality improvement within and across all sectors. The Guide does the following:

            Lists principles which will underpin awareness raising and staff development
            Identifies typical audiences, foci and outcomes for events
            Reviews possible range of events
            Provides a guide to content of pack of staff development materials
            Gives general guidance on the management of training sessions.

3.18. Principles underpinning integrated self evaluation are elucidated as follows:

            All organisations that are responsible for delivery evaluation and
             improvement of services for children take responsibility for awareness raising
             and development of staff
            A consistent approach across the country and services is needed so that
             separate services follow consistent approaches to evaluation
            There is a cross-sector, collaborative approach to the delivery of staff
             development events
            Events are delivered at a local level in such a way as to share knowledge
             and experience of evaluation methods and encourage multi-disciplinary
             teamwork
            Events recognise that a wide spectrum of interest will have to be
             accommodated
            Evaluation is build into events.


4.     National enquiries into significant cases

4.1.   Enquiries into significant cases that have influenced child welfare and protection
       work are:

            Social Services Inspectorate Inspection of Social Services in Cambridgeshire
             (Rikki Neave Inquiry), DOH, 1997
            Lord Laming, The Victoria Climbie Inquiry, HMSO 2003
            O’Brien et al Report of the Caleb Ness Inquiry, Edinburgh and Lothian Child
             Protection Committee, 2003



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             Dr Helen Hammond Inquiry into the circumstances surrounding the death of
              Kennedy McFarlane, Dumfries and Galloway Child Protection Committee,
              2000
             Professor Pat Cantrill Serious Case Review, Sheffield Area Child Protection
              Committee, 2005
             An Inspection into the Care and Protection of Children in Eilean Siar (The
              Western Isles Report), Social Work Inspection Agency, 2005
             Dr. Jean Herbison Danielle Reid: Independent Review into the
              circumstances surrounding her death, Highland Child Protection Committee,
              2006


5.     Legislative Background
5.1.   The Children Scotland Act (1995) embraces the principals of the United Nations
       Convention on the Rights of the Child. These are:

             Protection from ill-treatment and harm
             Participation in decisions affecting them
             Provision of services to meet their needs.

5.2.   Three overarching principals that govern the Act are:

             The child’s welfare is to be paramount consideration
             Consideration must be given to the child’s views
             The no order principal (principal of minimum intervention).

5.3.   The Children Scotland Act (1995) sets out provision for three new orders. These
       are:

             Child Protection Orders
             Child Assessment Orders
             Exclusion Orders.

5.4.   Child Protection Orders give provision for the immediate removal of a child for a
       period of eight working days with inbuilt appeal mechanisms within this. Child
       Assessments Orders last for 7 days. Exclusion Orders allow for the alleged abuser
       to be excluded from the family home in order to avoid the child being removed.


6.     Roles and responsibilities of NHSGGC staff
6.1.   NHSGGC Organisation (see APPENDIX 3)

6.1.2. Chief Executive

       It is the role of the Chief Executive to exert leadership on the protection/wellbeing of
       children and to elucidate the vision for children’s services.

6.1.3. Strategic planning


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      The role of the Strategic planning section is to plan and performance manage child
      protection/wellbeing services. This is done via the NHSGGC Child Protection
      Forum that is supported by the Child Protection Unit. The CPU was set up to:

           Strengthen the organisation and ensure it meets its responsibilities
           Ensure child protection responsibilities can be properly discharged
           Ensure NHSGG&C is properly organised to operate in multi agency
            arrangements
           Improve the protection of vulnerable children and those in the formal system
           Ensure access to expert advice and support
           Promote seamless care for children in the child protection process
           Improve communication processes and support information sharing across
            the health care system and partner agencies
           Ensure equity of service provision to staff
           Promote standardisation and consistency of child protection practice through:
           Guidelines, policies, and procedures
           Training and education
           Universal documentation, proforma, and tools
           Performance monitoring
           Work towards framework for standards
           Support clinical governance framework through clinical audit
           Ensure notification and management system for referrals to and from social
            work
           Support Child Protection Forum
           Review all referrals and trigger timely and appropriate NHS input
           Ensure NHS is effective at child protection committees
           Manage NHS input to significant case reviews.

6.1.4. Community Health and Care Partnerships - CH(C)Ps

      CH(C)Ps must make arrangements to ensure that, in discharging their functions,
      they have regard to the need to protect and promote the wellbeing of children.
      CH(C)P Directors are responsible for ensuring that the health contribution to
      promoting child protection/wellbeing is discharged effectively across the whole local
      health services. This role relates to both clinical services and wider public health
      responsibility for the local population. There must be integrated working across
      agencies to provide joined up services and a specific named health professional
      who has overall responsibility for ensuring adequate provision of services for
      vulnerable children.

6.1.5. Acute Directorates

      The Acute Directorates must make arrangements to ensure that, in discharging
      their functions, they have regard to the need to protect and promote the wellbeing of
      children. Acute Directors are responsible for ensuring that the health contribution to
      promoting child protection/wellbeing is discharged effectively across all its health
      services.

6.1.6. Key Health Departments



                                            16
6.1.7. Child Protection Unit

      The Child Protection Unit should provide:

            Advice and support
            Training
            Significant Case Review input
            Policy and procedure
            Management information
            Quality assurance and inspection support
            Support to the paediatric and forensic medical service.

      (See APPENDIX 4)

6.1.8. Human resources and recruitment

      Human Resources and Recruitment Directors must ensure that there are robust
      safe recruitment policies and practices, including enhanced disclosure checks for
      those who work with children.

6.1.9 Accident and Emergency Service

      A & E staff should be able to recognise certain injuries that are highly indicative of
      child abuse and take appropriate action. A & E staff should also be conscious of the
      potential risk to children in situations where a parent/ carer presents to an
      emergency department in concerning situations e.g. following injuries from domestic
      abuse, intoxicated, exhibiting mental health problems.

      Staff should know how to access the child protection register and be familiar with
      the process of seeking that information. Staff should know how to contact social
      work department at all times.

      Staff should be acquainted with the arrangements to notify the health visitor or
      school nurse of all visits made by children and young people under the age of
      sixteen to emergency departments.

      Staff should be familiar with the recording and reporting systems in place for all
      cases where child abuse is suspected.

6.1.10. Substance Misuse/Addiction Services

      The emphasis for staff working in this field is on the early assessment of parents
      who are misusing substances so that they can establish contact with other
      professionals involved in working with pregnant women or parents with young
      children.

      Children and young people who are misusing substances may also be at risk and in
      need, so consideration should be given to involving social work staff.



                                            17
      Staff should be aware of local child protection policies and guidelines and know the
      standard procedure for referring children and young people to social work
      department.

6.1.11. Mental Health services

      Health professionals who work with adults with mental health problems should
      always be aware of how the parents` mental state impacts on any children in the
      family.

      Mental Health staff should liaise with colleagues in children’s services if they have
      concerns that their patient is unable to provide the emotional support or physical
      care for the children.

      Staff working in adult mental health should also be aware that children of parents
      with chronic illness may become carers. This often leads to social isolation and a
      lack of emotional support.

      When a parent’s behaviour or mental state poses a risk of abuse or neglect of the
      child, professionals need to take immediate action to protect the child by referring
      them to social work department. Staff should therefore be aware of and be familiar
      with child protection the policies and guidelines.

      Where patients who are parents or carers of children are misusing drugs or alcohol
      staff should communicate with other professionals particularly those involved in the
      care of the children.

      Staff working in community settings should ensure that the welfare of any children
      in those settings is paramount.

      Mental Health Professionals involved in assessing abusers should ensure that
      reports written for other agencies or for child protection case conference make a
      clear statement of the risk to any child with whom the abuser has contact regardless
      of diagnosis or treatment.

      Staff should also remember that issues of confidentiality are over ridden in
      circumstances where child protection is an issue and that the protection of a child is
      paramount.

      Mental Health staff should also monitor the appropriateness of either children
      visiting adults in their care or those adults visiting children in hospital.

6.1.12. Child and Adult Mental health Services (CAMHS)

      Child and Adolescent Mental Health teams have a clear role in the follow up of
      abused children and young people.

      Staff who work in Child and Adolescent Mental Health Services may recognise, or
      come to suspect, that a child has suffered or is at risk of suffering significant harm.
      Staff need to be fully conversant with local child protection policies and procedures.



                                             18
       Staff should be aware of the referral process and require to focus on the needs of
       the child and young person. It is important to remember that the welfare of the child
       and that of any other child within the family is paramount.

       The child and adolescent mental health teams may also have a role to play in the
       assessment of an abuser if that abuser is a child or young person. Any reports that
       are produced should clearly state the assessment of risk to any child with whom the
       abuser has any contact with irrespective of diagnosis or treatment.

6.1.13. Other health departments

       All other health departments must make arrangements to ensure that, in
       discharging their functions, they have regard to the need to protect and promote the
       welfare of children. Examples of other departments are as follows:

             Psychology
             Laboratories
             Obstetrics and gynaecology
             Occupational therapy
             Physiotherapy
             Podiatry
             Sexual health services
             Speech and language
             Optometry
             Pharmacy.

       This list is not exhaustive.

6.1.14. All health staff

All NHSGGC health staff should:

             Have an awareness of the possibility that they may encounter children who
              have been abused and neglected and be alert to this possibility
             Understand that they have a duty to act on any concerns about child
              welfare/protection
             Know what to do if they have concerns
             Be aware of policy and procedure relevant to their work
             Be trained to a standard that equips them to carry out their child protection
              /wellbeing duties (see NHSGGC Strategic Training Plan 2007).

6.1.15. Health staff that work directly with children and families

All health staff that work with children and families should be able to:

             Recognise children in need of protection and/or support and understand risk
              factors
             Recognise risks of abuse to an unborn child
             Recognise the needs of parents who may need support in raising their
              children
             Know where to refer parents and children for help/support

                                              19
             Contribute to child welfare/protection inquiries/investigations by social work
              and/or police
             Contribute to multi agency assessment on the needs of children and the
              capacity of parents/carers to meet those needs
             Contribute to child protection key processes: tripartite discussions, case
              discussions, case conferences, core groups, children’s hearings, court
              hearings etc
             Ensure the provision of appropriate health services
             Contribute to significant case review processes
             Provide written reports where required and keep adequate case records.

6.1.17. Key health professionals

6.1.18. General Practitioners

It is unusual for children to be unregistered with a GP and GPs remain a crucial first point
of contact for many families experiencing difficulties. Their role is to identify, assess and
continue to manage those children experiencing abuse or at risk of abuse. They should:

             Have awareness of current legislation
             Provide early identification and support of vulnerable children and families
             Provide full cooperation and sharing of information with agencies
              investigating and undertaking assessments of children at risk
             Contribute to the significant case review process and understand
              implications for practice
             Be familiar with child protection policies and procedures
             Have an awareness of their role and responsibility in child protection,
             Have an awareness of employed staffs’ responsibilities and meet their
              training needs
             Receive appropriate training and at regular intervals
             Ensure robust systems are in practice to identify and manage vulnerable
              children and families
             Contribute actively in case discussions/conferences or provide adequate
              reports
             Provide on-going support and assessment to children who are cause for
              concern or who are on the Child protection Register
             Know how to formally refer to social work when required to do so
             Have awareness of different types of abuse and how they may impact on
              child’s physical, mental and sexual development
             Know where to access expert support and advice
             Where appropriate contribute to Comprehensive Medical Assessments and
              to ensure on-going medical care if identified.

6.1.19. Paediatricians

The role of the paediatrician is as follows:

             Recognise when both physical and psychological problems are present and
              when more that one condition or disorder may be present.



                                               20
   Recognise the diseases and host characteristics which make certain
    presentations life-threatening and manage these situations with vigilance and
    appropriate urgency
   Be able to assess and manage co-morbidities associated with the range of
    paediatric presentations
   Take a history from a child, young person and parent of the presenting
    difficulties to acquire information in sufficient breadth and depth in a range of
    possible symptom areas to allow accurate formulation of the problem
   Know when to gather information from other professionals eg those working
    in education, social work or from others who see the child in a variety of
    settings
   Have developed effective skills in the management of emotionally complex
    family situations
   Understand the importance of directing communications to the baby, child or
    young person as well as to parents and carers
   Know the range of patterns of normal development from birth to adulthood.
   Know and understand the range of children’s or young people’s
    psychological and social development, including the normal range and what
    is outside it.
   Understand the impact of other environmental factors (including violence,
    trauma, neglect, abuse and disruption, wherever this has occurred) on a
    child’s development, mental health and functioning
   Know the reasons for faltering growth, including emotional factors and how to
    investigate appropriately.
   Understand and assess normal and abnormal pubertal development and its
    relationship to growth
   Understand the indirect effects of substance misuse on mental and physical
    health, through experimental behaviour and lifestyle, the effects on
    educational, emotional and behavioural development and the impact on self-
    care skills
   Undertake comprehensive assessments, recognising indicators of significant
    organic disease, co-morbid, neuro-behavioural or developmental disorders
    (especially epilepsy and autism), interpretation of psychometric assessments
    and implications, reaching appropriate differential diagnosis and instituting
    appropriate management plans for children across the range of intellectual
    ability
   Have a sound knowledge of consent and parental responsibility in relation to
    child protection examinations and the health needs of looked after children
    and understand the relevance of the child’s care status
   Know how to assess and support the needs of children in families where
    there are child protection concerns
   Know the appropriate investigations and management of physical injuries in
    relation to abuse including use of radiology, medical photography and
    forensic tests and the limitation of these
   Know about forensic assessment in relation to child abuse and understand
    the importance of a chain of evidence
   Recognise the role of the Forensic Odontologist in relation to bite marks.
   Know when an expert genital examination is needed
   Know how to access help for appropriate investigation and management of
    sexually transmitted disease
   Know about emergency contraception and how this can be accessed

                                    21
             Are able to recognise fabricated and induced illness including the
              significance of repeated or bizarre physical symptoms and be able to take
              appropriate action and know when and where to access help
             Know the medical conditions that may mimic abuse of all kinds.
             Able to conduct an assessment for physical abuse
             Able to assess injuries in relation to history, developmental stage and ability
              of the child
             Able to recognise when additional expert advice is needed, for example
              radiology, orthopaedics, neurology, ophthalmology
             Able to recognise signs of abuse in disabled children and know that this
              group is more vulnerable
             Able to provide the medical opinion to case conferences, strategy meetings
              and court hearings
             Able to compile and write the range of reports required in child protection
              work including police statements, medical reports from social services and
              court reports.

6.1.20. Health Visitors

The role of the health visitor in Child Protection is to observe, assess record,
refer, and provide support. Child Protection work is an essential part of the role
and responsibilities of the health visitor. Health Visitors are accountable for their
practice in accordance with the NMC guidance and should ensure that the key
activities are undertaken with safe practice at their core.

The role of the health visitor includes:

             Early recognition of parenting and attachment difficulties
             Opportunity to monitor developmental wellbeing including physical
              and emotional development and to detect deviation from the norm
             Initiation of early intervention to prevent abuse and promote child
              wellbeing

Health Visitors have a responsibility to:

             Identify, assess and refer children at risk of abuse or neglect to the
              appropriate agencies
             Contribute to the prevention of abuse and neglect through supporting
              and working in partnership with vulnerable families
             Familiarise themselves with procedures for making referrals to social
              work departments
             Familiarise themselves with procedures and policies relevant to their
              work in Child Protection
             Work in partnership with colleagues to promote the wellbeing of
              children and prevention of abuse and neglect
             Contribute to the appropriate Child Protection Case Conferences,
              Discussions, Reviews and planning meetings for children on the
              Child Protection Register or who are giving cause for concern
             Be aware of how to seek advice and support e.g. from the Child Protection
              Unit and/or line managers.


                                              22
Health Visitors have a very important role to play in protecting children .

6.1.21 School Nurses

The role of the School nurses in Child Protection is to observe, assess record, refer, and
provide support.

The school nurse has a responsibility and opportunity to identify child protection and
wellbeing issues in several ways. This will include:

             Opportunistically during school health screening
             Through listening and observing children in the school environment
             Through informal approaches from children or through "drop-in clinics"
             Ensuring that records are up to date and accurate.

School nurses have a vital role and responsibility in relation to liaison with a variety of other
professionals where there are Child Protection concerns. This will involve:

             Contact with health visitors, particularly when children enter school or
              transfer between schools
             Discussion with school staff and guidance teachers where there are concerns
              about a child
             Liaison with parents where problems are identified within school
             Referral to other agencies including social work departments
             Contributing to the appropriate Child Protection Case Conferences,
              Discussions, Reviews and planning meetings for children on the Child
              Protection Register or who are giving cause for concern
             Be aware of how to seek advice and support e.g. from the Child Protection
              Unit and/or line managers.

6.1.22. Midwives

The role of the midwife in child protection is to assess and identify risk factors to
the child during the pregnancy, birth and post natal period both in the community
and hospital settings.

The responsibilities of the midwife include:

             Early identification of vulnerable women who are pregnant
             Preparation for parenthood for vulnerable women
             Familiarisation with procedures and policies relevant to their work in
              Child Protection
             Familiarisation with procedures for making referrals to social work
              departments
             Contributing to the appropriate Child Protection Case Conferences,
              Discussions, and Reviews and planning meetings for children on the Child
              Protection Register or who are giving cause for concern.
             Be aware of how to seek advice and support e.g. from the Child Protection
              Unit and/or line managers.




                                               23
6.1.23. Dentists

The role of the dentist in child protection is to identify physical injury especially to the
facial and oral regions.

They are also well placed to identify neglect which may include dental caries, poor oral
hygiene and the need for extensive dental extractions. This may include poor dental care of
children's teeth, unsuitable diet and failure by parents to seek and carry out appropriate
treatment or advice

The responsibility of the dentist is to assess and refer to Social Work departments where
they consider a child may have been physically injured or neglected. They should be
aware of local referral arrangements and have access to contact details should a referral
be appropriate

6.1.24. Other health professionals

All other health professionals should have knowledge of relevant procedure and should
receive training and supervision on child welfare and child protection. Examples of such
staff are as follows:

             Psychologists
             Psychiatrists
             Gynaecologists
             Counsellors
             Occupational therapists
             Physiotherapists
             Optometrists
             Pharmacists
             Podiatrists.

This list is not exhaustive.


7.     Key Definitions and Concepts
7.1.   Definition of a child

For the purpose of support for children in need and their families under the Children
(Scotland) Act 1995 “child” means a person under the age of sixteen years. Young people
between the age of sixteen and eighteen years who are still subject to a supervision
requirement by a Children’s hearing can still be viewed as a child.

7.2. Child Abuse

There is no standardised definition that has been developed by researchers and accepted
and used by practitioners. Definitions of child abuse vary amongst professionals, over
time and across cultures and between social and cultural groups. The World Health
Organisation state that the core elements of abuse should refer to;


                                                24
                    the child
                    the abusing agent; and
                    indirect harm caused by the abuse.

They provide a general definition of child abuse and maltreatment:

              “Child abuse or maltreatment constitutes all forms of physical and/or emotional ill
              treatment, sexual abuse, neglect or negligent treatment or commercial or other
              exploitation, resulting in actual or potential harm in the child’s health, survival,
              development or dignity in the context of a relationship of responsibility, trust or
              power”.

The official definition of child abuse in Scotland was devised by (Scottish Office Social
Work Services Group 1992) to provide standard criteria for admission to, and removal from
local registers:

              “Children may be in need of protection where their basic need are not being met in
              a manner appropriate to their stage of development and they will be at risk from
              avoidable acts of commission or omission on the part of their parent(s), sibling(s),
              from other relative(s), or a carer (i.e. the person(s) while not a parent who has
              actual custody of a child). To define an act or omission as abusive and/or
              presenting future risk for purpose of registration a number of elements must be
              taken into account. These include demonstrable or predictable harm to the child
              which must have been avoidable because of action or inaction by the parent or
              other carers” (Protecting Children a Shared Responsibility – Scottish Office 1998).

7.3.          Child Neglect

“This occurs when a child’s essential needs are not met and this is likely to cause
impairment to physical health and development. Such needs include food, clothing,
cleanliness, shelter and warmth. A lack of appropriate care results in persistent or severe
exposure, through negligence, to circumstances which endanger the child” (Protecting
Children a Shared Responsibility – Scottish Office 1998). Physical neglect may also
include a failure to secure appropriate medical treatment for the child, or when an adult
carer persistently pursues or allows the child to follow a lifestyle inappropriate to the child’s
developmental needs or which jeopardises the child’s health

7.4.          Child in Need

The concept of ‘need’ is defined in the Children (Scotland) Act 1995 P ll S.93 as follows:
“Any reference in this Part of this Act to a child being “in need”, is to his being in need of
care and attention because;

         i.        he is unlikely to achieve or maintain, or to have the opportunity of achieving or
                   maintaining, a reasonable standard of health or development unless they are
                   provided for him, under or by virtue of the Part, services by a local authority;
        ii.        his health or development is likely significantly impaired, or further impaired,
                   unless such services are provided;
       iii.        he is disabled; or
       iv.         he is adversely affected by the disability of any other person in his family;”



                                                     25
The legislation is intended to enable authorities to respond to a wide range of individual
needs.

7.5. Significant Harm

Some children are in need because they are suffering or likely to suffer significant harm.
The Children (Scotland) Act 1995 introduced the concept of significant harm as the
threshold that justifies compulsory intervention in family life in the best interests of children,
and gives local authorities a duty to make enquiries to decide whether or not they should
take action to safeguard or promote the welfare of a child who is suffering, or likely to
suffer, significant harm. Whilst the Act does not provide a definition for “significant harm”,
it is acknowledged that significant harm can be as a result of a ‘one off’ incident, a series
of ‘minor ‘ incidents or as a result of an accumulation of concerns over a period of time
(Inter-agency Guidelines GCPC 2001). In assessing significant harm, a number of factors
should be considered:

             the duration and the severity of the abuse
             the actual, or potential, impact on the child’s health, development or welfare
             the context of the any alleged incident i.e. age of the child, level of
              understanding etc
             parental attitude and willingness to co-operate
             the presence or absence of any protective factors
             the child’s reactions and/or views.

7.6.   Child Protection

Since the inquiry into the events at Cleveland the emphasis has shifted from a focus on
the concept of child abuse to a focus on the concept of child protection (Parton 1997). The
focus is on the identification of children who are being harmed or are likely to be harmed
and the action which may be taken to prevent further harm to such children. For social
workers and the police the focus of child protection is to protect children and young people
from abuse, they have a legal responsibility to investigate alleged instances of such abuse
and to follow legal and professional guidelines. Protecting Children A Shared
Responsibility (Scottish Office 1998) and Working Together to Safeguard Children
(Department of Health et al 1999) conform to this approach to defining child protection.


8.     Recognition
8.1.   The following section is adapted from “Child Protection Companion, Royal College
       of Paediatrics and Child Health, April 2006

8.2.   Bruises

Non abusive bruising in children has a direct correlation to the developmental stage of the
child under 5 years. Non mobile children should not have bruises without a clear and often
observed explanation. All such bruises should be carefully assessed including seeking
witness/independent observer accounts.

Certain areas are rarely bruised accidentally at any age, including neck, buttocks and
hands in children less than 2 years. Common and important sites for non accidental
bruises are:

                                               26
              Buttocks and lower back
              Slap marks on side of face, scalp and ears
              Bruises on external ear
              Neck, eyes and mouth
              Trunk including chest and abdomen
              Lower jaw and mastoid.

Two black eyes may follow blood tracking down from the forehead from a substantial
injury. This may involve the skin around the eyes but not the orbit. If this is accidental,
there should be a consistent account of an accident/incident a few days before (i.e. a
memorable event).

Bruises associated with sexual abuse include lower abdomen bruises, grip mark patterns
around buttocks, thighs knees and genitalia

The face is the most commonly bruised site in fatally bruised children.

Clustering of bruises or those which show a negative or positive image of an implement
are very significant.

8.3.   Bites

Bites are always inflicted injuries. They can be animal or human – adult or child.

8.4.   Fractures

It takes considerable force to produce a fracture in a child or infant. All fractures require
appropriate explanation and this must be consistent with the child’s developmental age.
Abusive fractures are frequently occult, particularly rib fractures (Merten, Radkowski &
Leonidas 1983). Assessment requires interface between paediatrician, paediatric A&E,
paediatric radiology and paediatric orthopaedics wherever possible (see RCPCH/RCR
2006).

Age

The younger the child the greater the likelihood of abuse. 80% of abused children with
fractures are less than 18 months old, whereas 85% of accidental fractures occur in
children over five years
Infants less than four months of age with fractures are more likely to have been abused

The following fractures are more suspicious of abuse:

Humerus

Spiral fractures of the humerus are uncommon and strongly linked with abuse. Any
humeral fracture other than a supracondylar fracture is suspicious of abuse in children
(Leventhal et al 1993; Strait, Seigel and Shapiro 1995; Thomas et al 1991; Worlock,
Stower and Barbor 1986).
All humeral fractures in a non-mobile child are suspicious if there is no clear
validated/witnessed history of an accident.


                                               27
Multiple fractures

Multiple fractures are significantly commoner in abused children, (Warlock, Stower &
Barbor 1986).

Ribs

In the absence of underlying bone disease or major trauma (such as a road traffic
accident), rib fractures in very young children are highly specific for abuse, and may be
associated in some cases with shaking.

Posterior rib fractures have never been described following resuscitation. Anterior and
costochondral rib fractures have been described extremely rarely, in 0.5% of resuscitated
children. If fractures are present on a chest x-ray after resuscitation they must be
investigated on the basis that they occurred before admission. Dating of the fractures may
be crucial in this assessment but the evidence suggests that this cannot be done with
accuracy. Remember anterior rib fractures may also occur in child abuse.

Posterior rib fractures are relatively more common in abuse and must be looked for
carefully, as they are easily missed. A skeletal survey must include oblique views of the
ribs to maximise detection

Femur

Femoral fractures in children who are not independently mobile are suspicious of abuse,
regardless of type.

Once a child is able to walk, they can sustain a spiral fracture from a fall while running.

A transverse fracture of the femur is the commonest presentation and can be found in
accidental and non-accidental injuries.

Skull fractures

Like other fractures, skull fractures require considerable force. A linear parietal fracture is
the commonest accidental and non-accidental fracture.

Other skull fractures require a greater degree of force, which should be reflected in the
history.

Up to 88% of abusive skull fractures occur under one year of age. This is also the
commonest age for accidental skull fractures.

8.5.    Emotional abuse

Emotional abuse is one of the most damaging forms of abuse and also almost always
accompanies other forms of abuse. It includes persistent criticism, denigration, rejection
and scapegoating.

Symptoms and signs are non-specific, and include the following:

Babies:

                                              28
               Feeding difficulties, crying, poor sleep patterns, delayed development
               Irritable, non-cuddly, apathetic, non-demanding. Described as: ‘difficult
                infant, not belonging to me’, ‘doesn’t love me’, ‘spoiled’. Also ‘greedy,
                attention seeking, lazy, in control of mother’.

Toddler and pre-school child:

Head banging, rocking, bad temper, ‘violent’, clingy. Spectrum from overactive to
apathetic, noisy to quiet. Developmental delay especially language and social skills.

School child:

Wetting and soiling, relationship difficulties, poor performance in school, non-attendance,
antisocial behaviour. Feel worthless, unloved, inadequate, frightened, isolated, corrupted
and terrorised.

Adolescent:

Depression, self harm, substance abuse, eating disorder, poor self-esteem. Oppositional,
aggressive and delinquent behaviour.

Categories of ill-treatment within emotional abuse and neglect

Emotional unavailability, unresponsiveness and neglect:

               The primary carers are usually preoccupied with their own particular
                difficulties such as mental health (including post-natal depression) and
                substance abuse or with overwhelming work commitments. They are unable
                or unavailable to respond to the child’s emotional needs, with no provision of
                an adequate alternative
               Extremely little or no emotional or psychological interaction between the
                carer and the child (emotional unavailability)
               Negative attributions and misattributions to the child
               Hostility towards, denigration and rejection or humiliation of a child, who is
                perceived as deserving these
               The child is repeatedly harshly criticised or blamed by the carer
               The child is ‘scape goated’ by the carer
               The child is described by the carer as having the ‘bad genes’ or the negative
                traits of a disliked or hated person

Developmentally inappropriate or inconsistent interactions with the child:

               Expectations of the child beyond her/his age and developmental capabilities
               Over-protection and limitation of exploration and learning, for example
                keeping child in pushchair for prolonged periods
               Exposure to confusing or traumatic events and interactions, for example,
                domestic violence, numerous changing partners, drug and alcohol abuse
               The parents/carers lack of knowledge of age-appropriate care giving and
                disciplining practices and child development, often because of their own
                childhood experiences. Their interactions with their children, while harmful,
                are thoughtless and misguided rather than intending harm


                                               29
             The child is given responsibility which he/she is developmentally unable to
              fulfil, for example, parenting younger children or caring for their own parents,
              or which impedes their development, for example, education, peer
              relationships, own protection
             The child is treated in a punitive, harsh or inappropriate manner as a result of
              the carer’s lack of awareness or understanding
             The child is exposed to confusing, distressing, disturbing or bizarre
              behaviour (e.g. intrafamilial (domestic) violence and parental (para) suicide)

Failure to recognise or acknowledge the child’s individuality and psychological boundary:

             Using the child for the fulfilment of the parent’s/carer’s psychological needs
             Inability to distinguish between the child’s reality and the adult’s beliefs and
              wishes
             The child is used by the carer as a partner, friend, confidant
             The child is expected to fulfil the parent/carer’s ambitions
             The parent/carer needs the child to be treated as ill; this includes Fabricated
              or Induced Illness (FII Section 6:12).

Failing to promote the child’s social adaptation:

             Promoting mis-socialisation (including corrupting)
             Psychological neglect (failure to provide adequate cognitive stimulation
              and/or opportunities for experiential learning)
             The child is deprived of the opportunity to develop peer relationships,
              including the carer not facilitating school attendance
             The child is allowed or encouraged to misuse illegal drugs
             The child is allowed or encouraged to be involved in criminal activities
             Failure to provide adequate cognitive stimulation, education and/or
              experiential learning; intellectual deprivation

8.6.   Neglect

Forms of neglect include:

             Neglect of a child’s physical needs, eg. Nutrition/hygiene/clothing
             Neglect of a child’s medical needs
             Neglect of supervision and lack of awareness of safety issues
             Failure to ensure the child receives stimulation and education appropriate to
              their age and level of development
             Neglect of a child’s social needs, eg. child not given opportunities to mix with
              peers
             Failure to provide affection and appropriate nurturing
             Failure to pay attention to child’s personal hygiene, clothing etc.

Presentations

             Frequent A&E attendance (eg. for injuries). These are often associated with
              accidents through lack of supervision
             Poor uptake/attitude to immunisations


                                              30
            Untreated medical conditions and not giving essential treatment regularly or
             consistently for serious illness and/or minor health problems
            Physical care and presentation of the child outside acceptable norms for the
             population (eg. Inappropriate clothing for the weather)
            Parent/carer does not have the ability and/or motivation to recognise and
             ensure the needs of the child are met

Assessment

Neglected children may present with:

            Failure to thrive through lack of understanding of dietary needs of a child or
             inability to provide an appropriate diet; or they may present with obesity
             through inadequate attention to the child’s diet
            Craving attention or ambivalent towards adults, or may be very withdrawn.
            Being too hot or too cold – check hands/feet for cold injury – red, swollen and
             cold hands and feet (Hobbs, Hanks and Wynne 1999) or they may be
             dressed in inappropriate clothing
            Consequences arising from situations of danger – accidents, assaults,
             poisoning, other hazards (lack of safeguarding)
            Delayed development and failing at school (poor stimulation and opportunity
             to learn)
            Difficult or challenging behaviour (failure of parenting)
            Unusually severe but preventable conditions owing to lack of awareness of
             preventive health care or failure to treat minor conditions
            Health problems associated with lack of basic facilities such as heating.

8.7.   Sexual Abuse

Children who have been sexually abused may present in many ways.

The abuser frequently grooms and threatens children so that a clear disclosure is not
often made at an early stage in the process.

There are very few absolutely diagnostic signs. The aim should be to build up a wider
jigsaw picture of the child which should include the child’s story, behaviour and
presentation.

The following are ways in which children may present – this is by no means an exhaustive
list, but a guide to the type of concerns, which should raise suspicions

Concerning signs/symptoms are:

            Vaginal bleeding
            Rectal bleeding
            Vulvo vaginitis with or without dysuria (pain on passing urine)
            Infection including anogenital warts
            Masturbation (It is normal for children to masturbate, however, this may be
             considered worrying if ‘excessive’- usually defined as excessive if in
             public/interfering with life. Masturbation does not usually cause physical
             signs or injury)

                                            31
               Foreign body in vagina/anus
               Soiling/bowel disturbance/enuresis
               Behavioural presentation:
                      o Children may present with various behaviours including self
                         harm/mutilation, aggressive and sexualised behaviours as well as
                         psychosomatic symptoms.
                     o Children can express their distress following sexual abuse in a wide
                       variety of ways (eg. Nightmares, poor school performance,
                       regression, anxiety and increased attachment behaviour). Any
                       major change in a child’s behaviour should prompt a search for the
                       cause and abuse should be considered if there is no obvious
                       explanation.
Definitive diagnostic presentations are:

               Pregnancy
               Some sexually transmitted infections.
               Presence of semen/sperm.

8.8.   Fabricated or Induced Illness (FII)

FII is a form of abuse, not a medical condition. Previously known as Munchausen
Syndrome by Proxy, this label applies to the child, not the perpetrator. The label is used to
describe a form of child abuse.

There is a spectrum of fabricated illness behaviour, and FII may co-exist with other types
of child abuse. The range of symptoms and systems involved is very wide and it is usually
the parent or care giver who is the perpetrator. FII includes some cases of suffocation,
non-accidental poisoning and sudden infant death.

Features are:

               A child is presented for medical assessment and care, usually persistently,
                often resulting in multiple medical procedures
               Mismatch or incongruity between symptoms described by parent/carer and
                those objectively observed by medical attendants
               The perpetrator denies knowledge of the aetiology of the child’s illness
               Acute symptoms and signs cease when the child is separated from the
                perpetrator
               Intentional or non-accidental poisoning often presents with bizarre
                symptomatology – a range of substances are involved (eg. Methadone, salt).

The paediatrician is usually the professional who firsts suspects FII.

8.9. Domestic violence/abuse

All professionals working with women and children should be alert to the inter-relationship
between domestic violence and the abuse and neglect of children.

Presentation


                                              32
             Effects on victim: social isolation, physical injuries, mental health problems
             Parenting problems: undermining of parenting ability and ability to protect
              children
             Effects on child: fearful, withdrawn, anxious, lacking in self confidence and
              social skills, difficulties in forming relationships, sleep disturbance, non-
              attendance at school, aggression, bullying, post traumatic stress disorder,
              behaviour suggestive of ADHD

8.10. Adult mental health and child protection

It is well recognised that parental mental health problems have a significant effect on the
well being of children and may lead to concerns about harm.

However, not all children whose parents are mentally ill suffer adversely as a result.
It is important that both Adult and Children’s services recognise the overlap between child
protection and parental mental illness. The best way forward is collaborative working
between these services.

8.11. Substance misuse

Parental problems, alcohol and drug use can, and often does, compromise children’s
health, development and welfare at every stage from conception onwards.
When parents are suspected to have a problem with substance abuse, the paediatrician
should consider the following questions:

General:

             Are there any factors which make the child(ren) particularly vulnerable, for
              example a very young child, or other social needs such as physical illness,
              behavioural and emotional problems, psychological illness or learning
              disability? Are there any protective factors that may reduce the risks of harm
              to the child?
             How does the child’s health and development compare to that of other
              children of the same age in similar situations?
             Are children usually present at home visits, clinic or office appointments
              during normal school or nursery hours? If so, does the parent/carer need
              help getting children to school?
             How much money does the family spend on alcohol/drug use? Is the income
              from all sources presently sufficient to feed, clothe and provide for children,
              in addition to obtaining alcohol/drugs?
             What kind of help do you think the child needs?
             Is there evidence of neglect, injury or abuse, now or in the past? What
              happened? What effect did/does that have on the child? Is it likely to recur?
             Is the concern the result of a single incident, a series of events, or
              accumulation of concerns over a period of time?
             Do the parents/carers perceive any difficulties and how willing are they to
              accept help and work with professionals?




                                              33
Drugs Specific:

            What arrangements are made for the child(ren) when the parent/carer goes
             to get illegal drugs or attends for supervised dispensing of prescription
             drug(s)?
            What do you think might happen to the child? What would make this likely or
             less likely?
            Do parent/carer(s) think that their child knows about their problems alcohol or
             drug use? How do they know?
            What does the child think? What do other family members think? How do
             you know?
            Is there a failure on the parent/carer(s) part to maintain contact with helping
             agencies?
            Who will look after the child(ren) if the parent/carer is arrested or is in
             custody?

Alcohol Specific (HMSO 2003; Scottish Executive 2003):

            What is the current pattern and level of use? Type and amount of alcohol
             consumed/where/when/alone or with others? If with others, with whom?
             When and where does this occur?
            Is this typical of the last three months?
            Tendency to binge drink or drink every day?
            How is alcohol financed?

9.    What to do if you are worried about a child
If you are worried about a child being abused or neglected or at risk of being abused and
neglected staff should do the following:

            Document exactly what you see and hear

            Report exactly what you see and hear to your supervisor, line manger or
             colleague

            If you need advice you can contact the Child Protection Unit Advice Line on
             0141 201 9225 (daytime) or the Medical Advice Line on (Out of Hours)
             contact RHSC Switchboard on 0141.201.0000

            Report your concerns to Social Work by telephone (See APPENDIX 6) and
             follow up in writing within 48 hours using Shared Referral Form. (See
             APPENDIX 8)

            If an emergency report your concerns to police on 0141 427 8081

Doing nothing is not an option.

(See APPENDIX 5 (Leaflet), APPENDIX 6 (social work contacts) APPENDIX 7 (Health
contacts))


                                            34
10. Tripartite Discussions (IRD’s – Initial Referral Discussions)

(See APPENDIX 9)

10.1. The involvement of the NHSGGC is an essential component in the multi-agency
      assessment of children at risk of child abuse and neglect. NHS involvement should
      take place during the course of all child protection investigations.

10.2. Arrangements to facilitate tripartite discussions are currently under development.
      The following has been agreed in some areas but at the time of writing full rollout is
      not yet implemented. Optimum arrangements are now described.

10.3. When a CP1 is opened, the responsible social worker discusses the case with
      relevant local NHS personnel such as the child’s Health Visitor, GP or School
      Nurse.

10.4. In every CP1 case, the responsible social worker also phones the NHSGGC Child
      Protection Unit (CPU) who gathers and shares additional Health information such
      as:

On site at Yorkhill

             CHI
             Reports to Reporter from HV
             NHS 24
             HISS (includes Yorkhill notes plus A & E cards)
             CPU Medical advice line
             CPU Nurse Advisor Advice line
             Missing Family Alerts
             Educational download.

In addition the following can be checked via telephone or email:

             DCFP/CAMHS
             Child Protection Advisors – Other Health Board Areas
             LAAC.

10.5. This information will be augmented over time and direct access via IT systems
      progressed.

10.6. During contact with the Child Protection Unit, if it appears that a medical may be
      required, an agreement will also be reached with a paediatrician on the following:

             Whether a one doctor comprehensive medical assessment is required, what
              it is likely to achieve and its urgency
             Whether a two doctor paediatric / forensic examination is required
             Who should conduct the medical assessment
             Where and when it should be conducted.




                                             35
10.7. When it has been agreed that a Comprehensive Medical Assessment is required
      the CPU will liaise locally with the appropriate paediatrician.

10.8. It is expected that the great majority of CP1 cases will be dealt with during working
      hours. After normal working hours, a medical assessment, if appropriate, may be
      arranged with the Consultant Paediatrician via the Royal Alexandra Hospital
      switchboard or via Yorkhill. (Later via Inverclyde Royal also).

10.9. All examining Paediatricians will use the standardised proforma for single and joint
      medical examinations.

10.11. Timing around Medical Assessments

            With physical injury it is important to arrange a medical as soon as possible
             so that signs of injury such as bruising do not fade
            If physical neglect is acute then an examination must be carried out as soon
             as possible. If not, time can be taken to arrange a comprehensive health
             assessment
            If there has been any form of recent sexual assault, it is imperative to
             arrange a medical examination at the earliest appropriate time
            In situations where the general practitioner is unsure whether the clinical
             presentation is due to abuse or illness, for example a child with unexplained
             severe bruising which could be due to a haematological condition, referral to
             the hospital for a paediatric opinion prior to initiating inter-agency discussions
             may be indicated. This would not be regarded as the formal planning
             meeting or discussion but a request for a paediatric opinion
            The child and family should be kept appropriately informed of the medical
             findings and should be supported throughout the process
            Once Child Protection investigations are under way, the progress of the
             health component will take place in parallel to other aspects of the police and
             social work enquiries.

10.12. Consent to Health Assessment

10.13. Children under 16 can give their own consent if the medical practitioner attending
       the child considers the child capable of understanding the nature and possible
       consequences of the procedure or treatment. If the child is judged capable, the
       practitioner must seek the consent of the child rather than of the parent.

10.14. Where a child is judged incapable of consenting, consent should normally be
       obtained from a person with parental responsibilities and rights.

10.15. It should be noted that, if a child is capable of giving his or her own consent, the
       parents lose any right they may have had to consent on the child’s behalf. This
       does not mean that parents must always be excluded from the discussions.
       Unless there are issues about the child’s confidentiality, it would be reasonable to
       involve parents in helping the child to reach a decision. This would be consistent
       with the philosophy of partnership with parents which underlies the Children
       (Scotland) Act. However, if the child is judged competent, it is the child’s consent
       alone that is legally effective.



                                             36
10.16. When a parent or carer is a suspect, or for some reason not supportive of their
       child’s needs, then their attendance during a health assessment may not be
       appropriate. Any exclusion of a parent or carer should be fully discussed by all the
       agencies in advance of the health assessment.

10.17. The child will be required to be accompanied by a parent or other trusted adult
       during this process.


11.   Paediatric and Forensic Medical Examinations

11.1. The following outlines the types of paediatric medical examination required when
      children are suspected of being abused or at risk of harm. There are four types of
      medical examination:

11.2. Comprehensive Medical Assessment

A Comprehensive Medical Assessment is an essential component in the multi-disciplinary
assessment of suspected/ potential child abuse or children at risk of harm. This would
involve the greatest numbers of children. Many chronically neglected children as well as
physically abused children do require this at some point. The Comprehensive Medical
Assessment has five purposes:

            Establish what immediate treatment the child may need
            Provide information which may or may not support a diagnosis of child abuse
             in conjunction with other assessments made, by analysis of facts and clinical
             presentations and provision of paediatric opinion. Agencies can initiate or
             continue enquiries as appropriate
            Provide information/evidence, if appropriate, to sustain care plans and/or
             criminal proceedings
            Secure any ongoing medical care (including cultural welfare/ mental health),
             monitoring and treatment that the child may require
            Assess and reassure the child and family as far as possible that no long term
             physical damage or health risk has occurred
            Record on standardised documentation (MCN standard) and provide reports
             as required to professionals, agencies and legal system.

11.3. Single Specialist Paediatric Examinations

These are provided in cases where there are possible indicators of sexual abuse but the
indicators are not sufficient to instigate a full police enquiry e.g. marked inappropriate
sexualised behaviour in a pre-school child with no allegation of abuse. Skilled intimate
examination of a child is also required when there is e.g. chronic vaginal discharge or
potential foreign body insertion. Social Work and Heath staff may in addition have ongoing
child welfare concerns and there may be anxieties expressed by the mother/carer re
potential problems or damage to the genital / anal area. Paediatricians with specialist
knowledge in intimate genital examinations are required to perform these examinations
within appropriate facilities. These cases are also sometimes referred by GPs or hospital
staff who have concerns regarding unusual genital anatomy in a child. A child clinical
vulvoscopy facility is the optimal setting.



                                            37
11.4. Joint Paediatric/Forensic Medical - Two Doctors – optimally Consultant
      Paediatrician and Police Child Examiner. This is conducted if:

             The child urgently requires a follow-up assessment investigation or treatment
              at a Paediatric Department e.g. head injury, possible fractures/unusual
              bruising/burns patterns
             The account of the injuries provided by the carer does not provide an
              acceptable explanation of the child’s presentation
             The result of the preliminary assessment is inconclusive and a specialist
              opinion is required to establish the diagnosis
             Lack of corroboration of the allegation such as a clear statement from
              another child or adult witness indicates that forensic examination, including
              the taking of medico-legal photography, may be necessary as part of the
              process to support legal remedies to protect the child and criminal
              proceedings against the perpetrator
             The child’s condition (e.g. failure to thrive/ malnutrition) requires further
              investigation.
11.5. Specialist Paediatric Examination/ Shared Care with other Medical and
      Surgical Specialists -

       e.g. general paediatric surgeons, burns surgeons, paediatric orthopaedic surgeons,
       general surgeons, psychiatrists

       These medicals are generally the most complex cases and are requested mainly
       via two routes:

             Other medical specialist currently in charge of the child’s clinical care
             Police / social work investigating the case requiring more specialist
              advice/opinion.

They are requested because the consultant involved has reached their level of
competency in their area and require specialist advice/opinion./shared care. Shared care
is where the specialist child protection paediatrician provides analysis and opinion in
relation to for example patterning of injuries, consistency or otherwise of history provided,
for clinical presentations, interpretations of sexually transmitted infections in children,
balanced judgement with regard to differential diagnosis in unusual features of
presentation.


12.    Adolescents 13 – 16 years or 18 if looked after and accommodated
       by local authority): Paediatric and Forensic Medicals
12.1. The aim is to ensure early Identification of child protection / wellbeing concerns at
      point of health contact / input.

12.2. Staff within particular health areas have a key role to play:
            A & E Departments
            GP Practices
            GEMS
            Minor Injury Units
            Paediatric departments (in future seeing more adolescents patients)
                                              38
            Community Paediatricians and Integrated teams within CHCP’s
            Sexual Health Services
            Mental Health Services
            Learning Disability Services
            Homelessness Services.

12.3. Early information must be shared within Health and with other agencies, in
      particular with social work departments and police, as per interagency Child
      Protection guidelines, to ensure appropriate assessment and/or investigation and
      intervention (and not be hindered by individual/subjective views on
      consent/confidentiality).

12.4. Comprehensive medical assessments and / or paediatric forensic medical
      assessments should occur within nominated appropriate Health facilities by
      appropriately trained medical staff and specialist nursing staff. This may be in
      dedicated facilities within CHCP’s or within appropriate facilities in the hospital
      setting. Police Child Examiners should be available as required for joint
      examinations. In these circumstances there should be formalised arrangements put
      in place for ready access to Mental Health services when required

12.5. Standardised Health Service Child Protection documentation across Glasgow and
      Clyde for 12 - 16yr olds to document clearly and comprehensively all child
      protection / wellbeing concerns including body charts illustrating physical injuries
      (and appropriate medico-legal photography by medical illustration departments or
      police photographers) will be introduced.

12.6. Archway (Glasgow only) provides a service for adolescents that have been subject
      to acute serious sexual assault. Medical examinations in suspected or acute sexual
      assaults experienced by young people under 16 years considered “not competent”
      by set criteria or who have developmental immaturity will occur on “Archway”
      premises at the Sandyford Centre or when required on paediatric premises.
      Archway staff can contact the paediatricians on the 24/7 rota for advice and /or
      assistance.


13.   Sharing of information

13.1. Key legislation regarding information sharing is as follows:
            The United Nation Convention on Rights of the Child, 1989
            Age of Legal Capacity Act (Scotland) 1991
            The Children (Scotland) Act 1995
            The European Convention of Human Rights (ECHR)
            The Data Protection Act 1998
            Freedom of Information (Scotland) Act 2002.

13.2. There are several national documents that offer guidance on sharing of information.
      These are as follows:
            Sharing Information about Children at Risk – A Guide to Good Practice,
             Scottish Executive 2004
            Protecting Children: A Shared Responsibility (Interagency Guidance), 1998
                                             39
            Protecting Children: A Shared Responsibility Guidance for Health
             Professionals, 2000
            General Medical Council Guidance on Confidentiality, 2000
            Protecting and Using Patient Information: A Manual for Caldicott Guardians
             2000
            NMC Code of Professional Conduct 2004
            NHS Scotland Code of Practice on Protecting Patient Confidentiality, 2003
            Responsibilities of Doctors in Child Protection cases with Regard to
             Confidentiality, RCPCH 2004.

13.3. General principles are as follows:
            All staff have a responsibility to act to make sure that all children are
             protected from harm
            Appropriate care is dependent on those providing that care having ready
             access to relevant information
            If there is reasonable concern that a child may be at risk of significant harm
             this will “always override a professional or agency requirement to keep the
             information confidential” CMO (2004)

13.4. Where possible staff should involve children and parents in the decision to share
      information. However, the paramount consideration is the care and wellbeing of the
      child. Children and parents need not be involved in decisions about the disclosure
      of information if this would increase the risk to the child, parents or staff.

13.5. When any professional approaches another to ask for information they should
      explain:

            What information they need
            Why they need it
            What they will do with the information
            Who else may need to be informed if concerns about a child persist.

13.6. If a professional is asked to provide information, they should never refuse solely on
      the grounds that all their information is confidential. They should consider:

            What information the service user has already given permission to share
            Any perceived risk to a child which would warrant breaching confidentiality
            Any relevant information on risk to the child, which would allow another
             agency to offer appropriate help and services or take action to reduce the
             risk to the child.

13.7. Staff should record when, what and why information has been shared, and with
      whom.


14.   Early sharing and collation of information

14.1. Several national policy documents and Significant Case Reviews have highlighted
      concerns about the lack of timeous and comprehensive collation of information,
      which often hampers decision making. Access to as full a range of information

                                            40
       regarding children where there are child welfare concerns is crucial to their
       protection. Current systems are complex, often difficult to navigate around, and
       where a child is known to multiple health services, information is held in several
       locations and not always cross-referenced. This can be frustrating and confusing for
       partner agencies, particularly at the early stages of any child protection
       investigation. Since the inception of the Child Protection Unit in 2005 work has been
       done to develop and maintain systems which help to inform and support the work of
       the Unit in a variety of ways. This has yielded a rich source of information either
       held locally or easily accessible by Unit staff. This information can be shared with
       partner agencies when considered appropriate to do so to support child protection
       processes.

14.2. The Child Protection Unit acts as a “one stop shop” for social workers at the initial
      stage of information gathering following a child protection concern being raised.
      This process should augment already existing social work systems. On receipt of a
      telephone enquiry administrative staff access health databases and where
      necessary, other available information in relation to an identified child or children. It
      is currently possible to access health data from a variety of sources available within
      the Unit, and this information can be made available very quickly. Information being
      sourced outwith the unit takes longer. The aim is to provide social work, police and
      health colleagues with a list of health services together with names and contact
      details of key individuals who have been involved with the child, within 24 – 48
      hours. A summary of key information contained in the directly accessible data
      sources is also provided. The information collated is reviewed by the Advisor on
      duty prior to sharing.

14.3. Advantages of the system are as follows:

             One point of contact for social work, police and health service in identifying
              sources of health
             information
             Speedy access to a range of health systems
             Identification of key health personnel who have involvement/information about
              a child - this may be
             particularly relevant for the over 5’s and those children accessing a wide
              range of health services
             Historical, as well as current data can be accessed - this may be particularly
              helpful in relation to previous attendances at A&E, previous admissions to
              hospital and history of G.P registrations
             As the CPU is housed within the Royal Hospital for Sick Children (Yorkhill),
              case notes from here can be accessed and reviewed by a Nurse Advisor to
              identify any relevant information
             Health information outwith Glasgow and Clyde area can be included
              (although not fully comprehensive)
             Inclusion of health information in the investigation process allowing decisions
              and actions to be based on as comprehensive a range of information as is
              possible.

14.4. Limitations are as follows:

             Process is heavily reliant on IT systems and therefore is only as good as the
              data on file

                                              41
             Not all systems can be accessed, e.g. A&E sites other than Yorkhill, although
              work is ongoing to improve this
             There may be some unavoidable delays due either to IT problems,
              organisational change leading to difficulties in sourcing information or
              complexities in identifying the child. (e.g. changes of surname, different
              spellings of names etc)
             This service does not at this stage, include full analysis of all health
              information.

14.5. A template has been designed for use in recording this information. (See
      APPENDIX 10.) A copy will be passed to the social worker, police or health worker
      requesting the information and a copy retained in the CPU for monitoring purposes.


15.    Training

15.1. All staff should be trained in child welfare and protection to ensure competency in
      the discharge of their duties. A framework for standards in this area is set out in the
      NHSGGC strategic Training Plan 2007. A training calendar of courses is produced
      regularly by the Child Protection Unit.


16.    Key contributors

       NHSGGC Child Protection Unit

       NHSGGC Child Protection Forum

       NHSGGC Operational Group (Partnerships)

       NHSGGC Operational Group (Acute)



17. Consultation process
17.1. Consultation via email with the following took place:

       NHSGGC Child Protection Forum

       NHSGGC Operational Group (Partnerships)

       NHSGGC Operational Group (Acute)

       Child Protection Committee Lead Officers

       Yorkhill Family Council




                                             42
APPENDIX 1

             Getting it right for every child




                            43
APPENDIX 2




                                                                     W
                                            Being Healthy




                                                                      ha
                                                                              Everyday care and help




                                                                        tI
                                                                         ne
                          Learning and achieving                                     Keeping me safe




                                                                          ed
                                                                             f
                                                          p




                                                                               rom
                   Being able to communicate                                             Being there for me




                                                      el o
                                                    ev




                                                                                  pe
                   Confidence in who I am                                                       Play, encouragement and fun




                                                  dd




                                                                                     ople
                                               an
                Learning to be                                The Whole Me                        Guidance, supporting me to




                                                                                         wh
                responsible
                                            row            Physical, social,                      make the right choices




                                                                                            o
                                        Ig




                                                                                            loo
             Becoming independent,                          educational,
                                      w

                                                                                                        Knowing what is going to




                                                                                                ka
             looking after myself                         emotional, spiritual
                                     Ho



                                                                                                        happen and when




                                                                                                  fte
                                                           & psychological




                                                                                                   rm
             Enjoying family and                            development                                     Understanding my
             friends




                                                                                                        e
                                                                                                            family’s background
                                                                                                            and beliefs
                                                       My wider world
                     Support from family,       School         Enough money    Work opportunities for my family
                     friends and other people          Local resources   Comfortable and safe housing         Belonging
                        APPENDIX 3
                                                                                                         Board HQ

NHS Board                     Board Medical             Director of Corporate      Director of       Director of Human                Director of Public Health         Director of      Head of Board            Board Nurse
Chief Executive               Director                  Planning & Policy          Finance           Resources                        (Interim Director)                Communications   Administration           Director

Tom Divers                    Brian Cowan               Catriona Renfrew           Douglas Griffin   Ian Reid                         Linda de Castecker                Ally McLaws      John Hamilton            Rosslyn Crocket




  Acute                                                                                                                                                      Partnerships
  Services
Acute Division Chief                 Director of Acute Service                                                  Director of IT                         West Glasgow CHSCP
Operating Officer                    Strategy Implementation                                                    (Interim Director)                     Director Karen Murray (Acting)
                                     & Planning
Robert Calderwood                    Helen Byrne                                                                Keith Moore
                                                                                Medical Director                                                       East Glasgow CHSCP                  Glasgow Addiction Services Partnership
                                                                                Brian Cowan                                                            Director Mark Feinmann              Joint General Manager
                                                                                                                                                                                           Neil Hunter
                                                                                                                Head of Prescribing
     Director of Oral Health                Director of Regional Services                                       & Pharmacy Policy                      North Glasgow CHSCP
     Kevin Hill                             Jonathan Best                       Nurse Director                                                         Director Alex McKenzie
                                                                                Margaret Smith                  Kate McKean                                                                Mental Health Partnership
                                                                                                                                                                                           (Interim Director)
                                                                                                                                                       South West Glasgow CHSCP            Anne Hawkins
     Director of Facilities                 Director of Women &                                                                                        Director Iona Colvin
     Alex McIntyre                          Children’s Services                 Head of HR                      Head of Clinical
             APPENDIX                       Rosslyn Crocket                     Anne Macpherson                 Governance
                                                                                                                                                       South East Glasgow CHSCP            Learning Disabilities Partnership
                                                                                                                Andrew Crawford                        Director Cathie Cowan               Joint General Manager
     Director of Diagnostics                Director of Emergency Care                                                                                                                     Michael McClements
     Jim Crombie                            & Medical Services                  Finance Director
                                            Grant Archibald                     Peter Gallacher                                                        East Dunbartonshire CHP
                                                                                                                Director of Health                     Director James Hobson (Acting)
                                                                                                                Information                                                                Glasgow Homelessness Partnership
     Director of Surgery &                  Director of Rehabilitation &                                                                                                                   Head of Homelessness Partnership
     Anaesthetics                           Assessment                          Head of Admin                   Situation Vacant                       West Dunbartonshire CHP             Catherine Jamieson
     Jane Grant                             Anne Harkness                       Gavin Barclay                                                          Director Keith Redpath


                                                                                                                                                       East Renfrewshire CHCP
                                                                                                                                                       Director Julie Murray
APPENDIX 4
C
r
APPENDIX 6

Social Work Contacts
Area Teams
Alexandria                         01389 608080
Barrhead                           0141 577 8300
Castlemilk Office                  0141 276 5010
Clarkston                          0141 577 4000
Clydebank                          0141 562 8800
Drumchapel Office                  0141 276 4300
Easterhouse Office                 0141 276 3410
Gorbals / Govanhill Office         0141 420 0060
Govan Office                       0141 276 8840
Greenock                           01475 714100
Johnstone                          01505 342300
Kirkintilloch                      0141 775 1311
Maryhill Office                    0141 276 6200
Paisley                            0141 842 4031
Parkhead Office                    0141 565 0140
Pollok Main Office                 0141 276 2940
Port Glasgow                       01475 714900
Renfrew                            0141 886 5784
Royston Office                     0141 276 7010
Rutherglen / Cambuslang            0141 647 9977
Social Work Out of Hours Service   0800 811 505
Social Work Out of Hours Service   0141 305 6706
( Health Staff Number Only)
APPENDIX 7

NHSGG Contacts
Child Protection Unit
Marie Valente      Head of Child Protection Development 0141.201.6970
Dr. Jean Herbison    Clinical Director of Child Protection   0141.201.9360
Dr. Kerry Milligan   GP SPi Child Protection                 0141.201.0468
Elaine Smith         Child Protection Advisor                0141.201.0484
Rita Brown           Child Protection Advisor                0141.201.0485
Anne Marie Knox      Child Protection Advisor                0141. 201.0484
Janice Brown         Child Protection Advisor                0141.201.0485
Fiona Miller         Child Protection Advisor                0141.201.0468
Carol Bews           Child Protection Advisor                0141.201.0468
Irene McGugan        Child Protection Advisor                0141.201.0468
Mhairi Cavanagh      Child Protection Trainer                0141.201.0489
Elly Albrow          Child Protection Trainer                0141.201.0489
Phyllis Orenes       Child Protection Trainer                0141.201.0489
Catherine Martin     Business Manager                        0141.201.0667
Dorothy Ramsden      PA Child Protection Advisors            0141.201.0642
Marian McGeever      Medical Secretary to CP                 0141.201.9225
                     Paediatricians
Lee Ramsay           PA Child Protection Trainers            0141.201.9253
Vacancy              PA to Clinical Director                 0141.201.9360
Sharon Menzies /     Child Protection Administrators –       0141.201.1740
Karina Hamilton      Early Sharing and Collation of
                     Information
NHSGGC Contacts Cont’d

HOSPITALS, GLASGOW
Hospital                  Switchboard
GRI                       211 4000
84 Castle Street
Glasgow G4 0AS
Royal Hospital for Sick   201 0000
Children (RHSC)
Dalnair Street
Glasgow G3 8SJ
Stobhill                  201 3000
133 Balornock Road
Glasgow G21 3UT
Southern General          201 1100
Hospital
1345 Govan Road
Glasgow G21 3UT
Victoria Infirmary        201 6000
Langside Road
Glasgow G42 9TY
Western Infirmary         211 2000
General
Dumbarton Road
Glasgow G11 6NT
Gartnavel Royal           211 3600
1055 Great Western
Road
Glasgow G12 0XH
Gartnavel General         211 3000
1053 Great Western
Road
Glasgow G12 0YN
NHSGGC Contacts Cont’d

HOSPITALS
CLYDE
Hospital                    Switchboard
Royal Alexandria Hospital   887 9111
(RAH)
Corsebar Road
Paisley PA2 9PN

Inverclyde Royal            01475
Larkfield Road              633777
Greenock PA16 0XN
Inverclyde                  01475
Skylark (Pre-School)        633777
Larkfield Road              (Inverclyde
Greenock PA16 0XN           Royal
                            Switchboard)
Vale of Leven               01389
Main Street                 754121
Alexandria G93 08A


Other Services
Service   Contact Name                     Contact Number
NHS 24    Gwen Proctor                     0131 300 4418 / 0131 300
          Norseman House                   4401
          South Queens Ferry               Mobile – 07795 052433
          Edinburgh
GEMS      For Glasgow & Clyde              616 6200
          Joan Barr                        Fax – 616 6201
          Joan.barr@gems.scot.nhs.uk       Mobile - 07717851046
NHSGGC Contacts Cont’d
CHPs
CHP                       CONTACT NAME                       CONTACT DETAILS
North Glasgow CHCP        Director – Alex MacKenzie          0141.201.4214
                                                             Alex.Mackenzie@ggc.scot.nhs.uk

East Glasgow CHCP         Director – Mark Feinmann           0141.277.7470
                                                             Mark.Feinmann@ggc.scot.nhs.uk

West Glasgow CHCP         Director – Karen Murray (Acting)   0141. 211 3647.
                                                             Karen.Murray@ggc.scot.nhs.uk
South West Glasgow CHCP   Director - Iona Colvin             0141.276.4673
                                                             Iona.Colvin@glasgow.gov.uk

South East Glasgow CHCP   Director – Cathie Cowan            0141.276.6710
                                                             Cathie.Cowan@glasgow.gov.uk

East Dunbartonshire CHP   Director – James Hobson (Acting)   0141.201. 4217
                                                             James.Hobson@ggc.scot.nhs.uk

West Dunbartonshire CHP   Director – Keith Redpath           01389.812334
                                                             Keith.Redpath@ggc.scot.nhs.uk
East Renfrewshire CHCP    Director – Julie Murray            0141.577.3844
                                                             Julie.Murray@eastrenfrewshire.gov.uk

South Lanarkshire CHP     General Manager – Lena Collins     0141.584.2509
                          (Rutherglen & Cambuslang           Lena.Collins@ggc.scot.nhs.uk
                          Locality)
Renfrewshire CHP          Director – David Leese             0141.314.0439
                                                             David.Leese@renver-pct.scot.nhs.uk
Inverclyde CHP            Director – David Walker            0141.201.4754
                                                             David.Walker@renver-sct.scot.nhs.uk
NHSGGC Contacts Cont’d

Health Centres
Alexandria Medical Centre         01389 752 419   46-62 Bank Street       G83 0NB
Baillieston Health Centre         0141 531 8000   20 Muirside Road        G69 7AD
Bank Street (Alexandria) Clinic   01389 81700     46-62 Bank Street       G83 0LS
Bishopton Health Centre           01505 863223    Greenock Road           PA7 5AW
Boglestone Clinic                 01475 701058    Dubbs Road              PA14 5UA
Bridgeton Health Centre           0141 531 6500   201 Abercromby Street   G40 2DA
Cambuslang Clinic                 0141 641 2085   Johnston Drive,         G72
Cambuslang Gate                   0141 584 2509   Main Street,            G72
Cardonald Clinic                  0141 892 6070   74 Berryknowes Road     G52 2TT
Castlemilk Health Centre          0141 531 8500   Dougrie Drive           G45 9AW
Clarkston Clinic                  0141 300 1200   56 Busby Road           G76 7AT
Clydebank Health Centre           0141 531 6300   Kilbowie Road           G81 2TQ
Drumchapel Health Centre          0141 211 6070   80/90 Kinfauns Drive    G15 7TS
Dumbarton Health Centre           01389 763 111   Station Road            G82 1PW
Easterhouse Health Centre         0141 531 8100   9 Auchinlea Road        G34 9HQ
Elderpark Clinic                  0141 232 7100   20 Arklet Road          G51 3XR
Erskine Health Centre             0141 812 4044   Bargarran Square        PA8 6BS
Erskineview Clinic                01389 872575    Erskineview             G60 5JG
Ferguslie Clinic                  0141 849 0554   Tannahill Centre        PA3 1NT
Fernbank Clinic                   0141 589 8000   194 Fernbank Street     G22 6BD
Foxbar Clinic                     01505 813119    Morar Drive             PA2 9QR
Glenburn Health Centre            0141 884 3221   Fairway Avenue          PA2 8DX
Gorbals Health Centre             0141 531 8200   45 Pine Place           G5 9AW
Gourock Health Centre             01475 634617    181 Shore Street        PA19 1AQ
Govan Health Centre                       0141 531 8400   5 Drumoyne Road            G51 4BJ
Govanhill Health Centre                   0141 531 8300   233 Calder Street          G42 7DR
Greenock Health Centre                    01475 724477    20 Duncan Street           PA15 4LY
Hunter Street Health and Social Care      0141 553 2801   55 Hunter Street           G4 0UP
Centre
Johnstone Health Clinic                   01505 320278    60 Quarry Street           PA5 8EY
Kenmure Medical Practice                  0141 772 6309   7 Springfield Road         G64 1PJ
Kessington Medical Centre                 0141 211 5621   85 Milngavie Road          G61 2DN
Larkfield Child & Family Centre           01475 633777    Larkfield Road             PA16 0XN
Lennoxtown Clinic                         01360 310357    103 Main Street            G65 7DB
Linwood Health Centre                     01505 324337    Adrlamont Square           PA3 3DE
Maryhill Health Centre                    0141 531 8700   41 Shawpark Street         G20 9DR
Milngavie Clinic                          0141 232 4800   North Campbell Avenue      G62 7AA
Muirhead Clinic                           0141 779 1941   192 Cumbernauld Road       G69 9NF
New Sneddon Street Clinic                 0141 848 1296   8 New Sneddon Street       PA3 2AD
Parkhead Health Centre                    0141 531 9000   101 Salamanca Street       G31 5BA
Partick Community Centre for Health       0141 211 1400   547 Dumbarton Road         G11 6HU
Plean Street Clinic                       0141 232 4708   18 Plean Street            G14 0YJ
Pollok Health Centre                      0141 531 6800   21 Cowglen Road            G53 6EQ
Pollokshaws Clinic                        0141 577 7720   35 Wellgreen               G43 1RR
Port Glasgow Health Centre                01475 724477    2 Bay Street               PA14 5EW
Possilpark Health Centre                  0141 531 6120   85 Denmark Street          G22 5EG
Renfrew Health Centre                     0141 886 3535   103 Paisley Road           PA4 8LH
Renton Integrated Healthy Living Centre   01389 722 250   Main Street                G82 4PD
Russell Institute                         0141 889 8701   30 Causeyside Street       PA1 1UR
Rutherglen Primary Care Centre            0141 531 6015   130 Stonelaw Road          G73 3PQ
Shettleston Health Centre                 0141 531 6200   420 Old Shettleston Road   G32 1RT
Springburn Health Centre          0141 531 6700   200 Springburn Way       G21 2DA
Thornliebank Health Centre        0141 531 6900   20 Kennishead Road       G46 8NY
Torrance Clinic                   01360 620 516   51 Main Street           G64 4EX
Townhead Clinic (Kirkintilloch)   0141 304 7400   Lenzie Road              G66 3BQ
Townhead Health Centre            0141 531 8900   16 Alexandra Parade      G31 2ES
Turret Medical Centre             0141 211 8260   Catherine Street         G66 1JB
William Street Clinic             0141 314 6200   120-130 William Street   G3 8HS
Woodside Health Centre            0141 531 9200   Barr Street              G20 7LR
           APPENDIX 8
                                                                                                                   Notification of concerns about a child to
                                                                                                                   Social Work Services.


 1a. REFERRAL DETAILS
Name of Referrer          Agency               Designation             Postal Address                 Email                               Phone         Fax
                                                                       (include postcode)




1b. DESIGNATED CONTACT PERSON (IF DIFFERENT FROM 1a)
Name of Referrer          Agency               Designation             Postal Address                 Email                               Phone         Fax
                                                                       (include postcode)




 2. REFERRAL TO
Date of        Time of         Name of worker spoken to      Designation                    Is the parent/carer aware    Is the young person aware of this referral?
Referral       Referral                                                                     of this referral?            Yes/No?
               (am or pm)                                                                   Yes/No?


Area/Hospital Social Work      Responsible Local             Phone                          Is this a re-referral from   If yes, please enter date(s) of previous
Team                           Authority                                                    your service? Yes/No         referral(s)
    3. SUBJECT OF REFERRAL

Child’s Name             Other name      DOB         Age       Gender       Home Address                 Ethnicity                     Religion
                         known by        dd mm yy              (M/F)        (include Postcode)

1

2

3


                                                                                   Child Affected by Disability
    Preferred Language                                                             Description                                    Communication Assistance
                                       Interpreter Required (specify)
                                                                                                                                  Required (specify)

1

2

3




4. FAMILY DETAILS

                     DOB          Other name         Current Address                                   DOB           Other name   Current Address
Mother’s Name                                                                         Father’s Name
                     (If Known)   known by           (If different from child)                         (if known)    known by     (if different from child)
4. FAMILY DETAILS (cont’d)                                                                 Principal Carer’s Details (if different from Mother/Father)

                                     Is Child
                                                                                                                                      Address
 Family Address       Phone          Currently          If No, state Address                          DOB              Relationship                  Type of Residence
                                                                                    Name                                              (including
 (include postcode)   (if known)     Resident at this   (include postcode)                            (if known)       to Child                      (if not at home)
                                                                                                                                      postcode)
                                     Address?Yes/No




Other Adults in Household                                                  Any Other Significant Adult(s) (if known, please include contact
details)
                        DOB                                                           DOB
Name                                  Relationship to Child       Name                              Address                  Phone         Relationship to Child
                        (if known)                                                    (if known)




Siblings not subject to referral
Child’s Name                          Other name known by                      DOB            Age             Gender        If in relation to unborn baby or mother is
                                                                               dd mm yy                                     pregnant – Estimated Date of Birth
5. SUMMARY OF CONCERNS

FOR ALL OTHER REFERRALS PLEASE COMPLETE THE FOLLOWING                                                IF APPLICABLE PLEASE COMPLETE

Suspicion/risk of (factors relating to the        Suspicion/risk of (factors relating to             Suspicion/risk of
child)                                            parents/ carers)
Absconding                                        Alcohol Abuse                                      Physical Injury
Child Safety                                      Asylum Seekers/Refugees                            Emotional Abuse
Education                                         Domestic Abuse                                     Physical Neglect
Emotional Care/Development                        Drug Abuse                                         Non-Organic Failure to Thrive
Health – Illness/Disability                       Housing/Accommodation                              Sexual Abuse
Outwith Parental Control                          Learning Disability
Physical Care/Neglect                             Mental Illness
Self harm                                         Parenting
Sexual Exploitation                               Physical Illness
Offender Behaviour                                Poverty/Financial
Substance Misuse                                  Other (please specify below)
Other (please specify below)




6. REASON FOR REFERRAL/REQUEST FOR SERVICES: (please record reason for concern and how this impacts on child. If
    applicable, please indicate alleged abuser. Indicate what action, if any, you have taken prior to the referral).


7. AGREED ACTIONS (Actions agreed during phone referral)
8. AGENCY INVOLVEMENT

                Health           GP’s Name                               Address   Phone   Email



         Health Visitor/School   Name of Health Visitor/School Nurse     Address   Phone   Email



              Education          Name of School and Contact Person       Address   Phone   Email
          (Nursery / School)



         Any Other Agencies      Name of Agency and Contact Person       Address   Phone   Email
             (if known)




                                                                       Please
                                                                       print
  Signature of Referrer                                                name
  Date
                                                                       Please
  Signature of Line Manager                                            print
  (if applicable)                                                      name
Acknowledgement of Child Welfare/Protection Referral To Social Work Services
Social Work Services use only (Return to Referrer within 5 working days)
Insert Social Work Services Address




Family Name

SWID No.

Date of Referral


Request Treated as:


Outcome of Referral/request for Services



Any other comments



Practice Team Leader Signature:

Date




                                                      2
APPENDIX 9




             3
APPENDIX 10
                                                      Early Sharing & Collation of Information Form

Date                                          Time                                      Received From (Advisor)
                                                                                        Received By (Admin)
CALLER DETAILS
Name                                                                                    Service

Area Office                                                                             Tel. No .                          Fax No.                                 Email

FAMILY DETAILS
Family Name

Family Address                                                                                                                                                 Postcode



CHP Area of Child /                           North                West                    South East       South West               Renfrewshire              East                  Inverclyde
Family                                        East Dun             West Dun                East Ren         South Lan                North Lan                 Other
Principal Carers
Name                                           Relationship to child                        Aliases                                     DoB (if known)




Other known addresses/
Dates of residence


Children (Index Child First)
           Forename                          Surname                        Aliases                 DoB         CHI           Care First          Gender           Nursery/School.
Child 1
Child 2
Child 3
Child 4
Child 5
Unborn                                                                                              EDD
REASON FOR REQUEST




INFORMATION AVAILABLE
1    CHI                                                                                            2     GP Registration History

       GP… ………………..……………..………….. ….……                                                                     Name… …… ………………..……………………………….
       ……..…………………………………………………....                                                                        Address/Tel…………………………………………………...
       …………..........................................................................                     Dates Registered…...................................................................

       HV…… … ………….……………….………………….                                                                        Name …. ……………………………………….………..…...
                                                                                                          Address/Tel.
       Address/tel. no, if different…………………..................                                             Dates Registered…………………………..………………....
       …………………………………………………………..

                                                                                                    4
3    Medical Advice Line (CPU)                                                                4    CPA Advice Line (CPU)

     Date(s)..… ………..……………………………………                                                                Date(s)………………………………………………………
     Name of Prof…………………………………………….                                                                Name of Prof … ………………………………………..……

     Summary/Outcome…………………………………...…                                                              Summary/Outcome…………………………………………
     ………………………………………………………...…                                                                     ………………………………………………………………
     ….…………………………………………………….…                                                                      ………………………………………………………………
     ………………………………………………………..…                                                                      ………………………………………………………………
     …………………………………………………………..                                                                      ……………………………………………………………….

5    Previous Referral by Health to Social Work (CPU)                                         6    Previous Referral by Health to SCRA CPU)

     Referred By…… ………………………………….…...                                                              Referred By…… ……………………………………….........
     …………………………………………………………..                                                                      ……………………………………………………………….

     Date(s)…………………………………………………                                                                    Date(s)…………………………..……………………………
     …………………………………………………………                                                                        ………………………………………………………………...

     Summary/Outcome……………………………………                                                                 Summary/Outcome………………………………………….
     …………………………………………………………                                                                        ………………………………………………………………..
     ………………………………………………………….                                                                       ………………………………………………………………..

7    Previous Reports by NHS 24 to CPU                                                        8    Missing Family Alerts (CPU)

     Submitted By …......                                                                          Submitted By ………… ……….…………..

     Date……………………………………………………                                                                      Date…………………………………………………………
     ………………………………………………….                                                                          ………………………………………………………………

9    Hospital Information Support System (Yorkhill)                                           10   Educational Download

     Hosp. No.                                                                                     School Nurse

     Dates/Department… ………….                                                                       Name… ………………….

     Case Notes Reviewed                                                                           Base ….… ……………………..
     By……………………………………………………….
                                                                                                   Tel No….………………..……………………
11   Clinical Portal (Clinic Visits - Glasgow)                                                12   Radiology System (Glasgow)

     Date(s)… …………........................................................                         Date(s)… …………………………………………………..
     Hospital(s)………………………………………………                                                                 Hospital……………………………………………………….
     Clinic................................................................................        Type of X-ray …… …………………………………………

     Date(s)…………………………………………………..                                                                  Date(s)…………………………………………………….…
     Hospital(s)………………………………………………                                                                 Hospital………………………………………………………
     Clinic................................................................................        Type of X-ray ………………………………………………..

13   EDIS (GRI/Stobhill/WIG)                                                                  14   Other A&Es

     Date(s)…….. ………………………….……………….                                                                Date(s)……..………………………… ………………………
     Hospital/                                                                                     Hospital/
     Clinic................................................................................        Clinic.........................................................................................

     Date (s)………………………………….………………                                                                  Date (s)………………………………….………………….…
     Hospital/                                                                                     Hospital/
     Clinic...............................................................................         Clinic.........................................................................................

     Date(s)……..… … …..………………………………..                                                              Date (s)………………………………….…………………….
     Hospital/                                                                                     Hospital/
     Clinic...............................................................................         Clinic.........................................................................................




                                                                                              5
INFORMATION AVAILABLE
15   Community Paediatricians (CDC)      16   DCFP/ CAMHS

     Name………………………....…………………………              Name………………………....……………………………….

     Base……………………………………………………                 Base………………………………………………………….
     ………………….………………..……………………                 …………….………………..…………………………………

     Dates Attended ………………………………………..         Dates Attended………………………………………………
     …………………………………………………………                   ………………………………….……………………………

17   Homeless Families Health Team       18   LAAC

     Contact Name…………………………………………..           Name………………………....……………………………….

     Dates……………………………………………………                Base…………………………………………………………
     …………………………………..………………………                 …………….………………..………………………………..
     Summary/Outcome……………………………………
     …………………………………………………………                   Dates Attended……………………………………………..
     ………………………………………………………….                  ………………………………………………………………..

19   Asylum Seekers Health Team          20   OTHERS AS APPROPRIATE

     Contact Name…………………………………………..           Service………………………………………………………

     Dates……………………………………………………                Relevant Contact……………………………………………
     …………………………………..………………………                 ………………………………………………………………
     Summary/Outcome……………………………………            ………………………………………………………………
     …………………………………………………………                   ………………………………………………………………
     ………………………………………………………….                  ………………………………………………………………

21   OTHERS AS APPROPRIATE               22   OTHERS AS APPROPRIATE

     Service…………………………………………………               Service…………………………………………………

     Relevant Contact ……………………………………….        Relevant Contact ……………………………………….
     …………………………………………………………                   ………………………………………………………………
     …………………………………………………………                   ………………………………………………………………
     …………………………………………………………                   ………………………………………………………………
     ………………………………………………………….                  ………………………………………….

ANY OTHER INFORMATION




Initial information collated by ……………………………. …………..………………………… (Admin Officer)

Passed to….…… ………………………………. ……..         Designation… …… ….…………… (CPA/SW)

Date….………….……………. Time………………………

Follow up completed by …………………………………….        Passed to ………………………

Date ……………………….. Time …………………………
                                         6
APPENDIX 11

Other related policies, procedures and guidance

     MC57 form - health monitoring and tracking

     Monitoring and tracking of missing family alerts

     Shared referral form to Social Work and guidance notes

     Working with sexually active young people – guidance for under 16 year olds

     Base 75

     Child Protection and Domestic Abuse

     Recognition and Management of Maltreatment in Children Under Age of One Year

     Suspected non-accidental head injury (NAHI) in children under 2

     Child Protection Significant Case Review Procedures for NHSGGC

     CP Text 4 U

     Young People Who are Sexually Active - GP Confidentiality (Sandyford)

     The Glasgow protocol for working with young people who are sexually active

     Health staff attendance at case conferences

     Perinatal Unit Admissions

     Procedures to be adopted by the Dental Professional who suspects child abuse

     Standard Operating Procedures (Yorkhill, being rolled out in RAH)

     Child Protection Guideline for NHS Staff working in A and E

     GP deregistration policy

     Early sharing and collation of information

     Children’s Right to Be Treated Fairly

     Child Protection Committees Interagency Guidance




                                                    7
APPENDIX 12

REFERENCES

Legislation

The Children Scotland Act (1995)

National Policy

Protecting Children: A Shared Responsibility - Guidance for Health Professionals, 1999

It’s Everyone’s Job to Make Sure I’m alright, Scottish Executive, 2002

Protecting Children and Young People: The Framework for Standards, Scottish Executive, 2004a

Protecting Children and Young People: The Charter, Scottish Executive, 2004b

Protecting Children and Young People, Child Protection Committees, Scottish Executive, 2005b

How Well Are Children and Young People Protected and Their Needs Met? Self Evaluation Using
Quality Indicators, HMIE, 2005

Evaluation of Services for Children and Young People: Generic Quality Indicators, HMIE, 2006

Getting It Right for Every Child: Proposals for Action, Scottish Executive, 2006

Delivering a Healthy Future: An Action Framework for Children and Young People’s Health in Scotland,
Scottish Executive, 2006

Have we got our priorities right? Children living with parental substance use, Aberlour, 2006

Hidden Harm – next Steps: Supporting Children- Working with parents, Scottish Executive, 2006

Emergency Care Framework for Children and Young People in Scotland, Scottish Executive, 2006

Guide to Evaluating Services for Children and Young People Using Quality Indictors” (2007) HMIE

Better Health, Better Care Action Plan, Scottish Government, 2007

NHSGGC documents

NHSGGC Strategic Training Plan (2007)

Inquires into child deaths

Social Services Inspectorate Inspection of Social Services in Cambridgeshire (Rikki Neave Inquiry),
DOH, 1997

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Lord Laming, the Victoria Climbié Inquiry, HMSO 2003

O’Brien et al Report of the Caleb Ness Inquiry, Edinburgh and Lothian Child Protection Committee, 2003

Dr Helen Hammond Inquiry into the circumstances surrounding the death of Kennedy McFarlane,
Dumfries and Galloway Child Protection Committee, 2000

Professor Pat Cantrill Serious Case Review, Sheffield Area Child Protection Committee, 2005

An Inspection into the Care and Protection of Children in Eilean Siar (The Western Isles Report), Social
Work Inspection Agency, 2005

Dr. Jean Herbison Danielle Reid: Independent Review into the circumstances surrounding her death,
Highland Child Protection Committee, 2006




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