SAFEGUARDING CHILDREN: CHILD PROTECTION by OfhU0k4

VIEWS: 0 PAGES: 81

									                                        NHS BRENT

                            SAFEGUARDING CHILDREN:

                                CHILD PROTECTION

                            POLICIES & PROCEDURES



                                 For NHS Brent Staff




To be read with:
London safeguarding children board procedures (2007)
Risk management policy
Critical incident reporting policy
Information governance policy
Consent policy
Serious Untoward Incidence policy
Safer recruitment policy
PDR policy
Record Management




Version 3.   Page 1 of 80     Child Protection policy and procedure Sep 2008   1
Document Reference Information


                   Version                                 2


                   Status                                  Ratified


                   Author/Lead                             Bernadette Halford/Dr Arlene
                                                           Boroda

                   Directorate Responsible                 Provider and Estates Services

                   Consultation                            Brent Health Safeguarding
                                                           Children Group.
                                                           Brent LSCB Procedure and
                                                           Policy Sub group
                                                           Professional Nurse Group
                                                           Senior Managers & Lead
                                                           Clinicians - Children Services.
                                                           NHS Brent Professional
                   Ratified By and Date                    Executive Committee
                                                           December 2008

                   Date Effective                          December 2008


                   Date of Next Formal Review              01.10 2009



                   Target Audience                         All staff working within NHS
                                                           Brent and contracted services




Version Control Record
 Version           Description of             Reason for Change              Author           Date
                    Change(s)

 1            Update legislation &        Expired                           Val Tyrell
              Guidance
              Addition of duties          Compliance with NHSLA            Bernadette        20.08.08
 2            /responsibilities of        Update consent guidance           Halford
              Safeguarding
              professionals. Quality
              assurance of document.
              Consent updated
              Format amended




Version 3.   Page 2 of 80           Child Protection policy and procedure Sep 2008                      2
Contents

                 Description                                                   Page No
                 Title Page … … … … … … … … … …                                      1
                 Document Reference Page … … … … … …                                 2
                 Version Control Record … … … … … … …                                2
                 Contents Page … … … … … … … … …                                     3
                 Appendix … … … … … … … … … …                                       52
Section 1        Policy Aim for Safeguarding Children       … … …                    6
Section 2        Introduction - Safeguarding Children is everyone’s
                 responsibility. … … … … … … … … …                                   6
Section 3        National Policy Legislation and Guidance       … …                  7
Section 4        Agency Roles … … … … … … … … …                                      8
Section 5        Local arrangements to safeguarding children – duties
                 and responsibilities of Safeguarding Professionals.                 8
Section 6        All Staff must follow specific guidance outlined in
                 LCPP (2007) … … … … … … … … …                                       9
Section 7        General Principles for safeguarding children for
                 Health Professionals      … … … … … … …                            10
Section 8        Working in partnership with Families       … … …                   10
Section 9        Common Assessment Framework – Change for
                 Children     … … … … … … … … … …                                   11
Section 10       Inter agency meetings … … … … … … …                                12
Section 11       Communication, confidentiality and information
                 sharing … … … … … … … … … … …                                      13
Section 12       Information received from a member of the public
                 expressing concerns about a child … … … …                          14
Section 13       Request for legal reports      … … … … … …                         14
Section 14       Media enquiries        … … … … … … … …                             15
Section 15       Consent       … … … … … … … … … …                                  15
Section 16       Parental responsibility … … … … … … …                              16
Section 17       Data Protection Act … … … … … … … …                                16
Section 18       Looked after children      … … … … … … …                           16
Section 19       Recognition of child abuse or neglect … … … …                      16
Section 20       Definitions of abuse … … … … … … … …                               17
Section 21       Children in specific circumstances who may be at risk
                 of suffering neglect … … … … … … … …                               17
Section 22       Using the Framework for the Assessment of Children
                 in Need and their Families … … … … … …                             19
Section 23       Actions in cases of sexual abuse (all clinicians) …                21
Section 24       Allegations of child abuse against any individual
                 working with children in NHS Brent … … … …                         21
Section 25       Children in whom illness is fabricated or induced …                22


Version 3.   Page 3 of 80     Child Protection policy and procedure Sep 2008             3
Section 26       Child death review process WT (2006) Section 7 …               23
Section 27       Procedures where there is death or serious harm to a
                 child under the age of 18 years … … … … …                      23
Section 28       Complex cases         … … … … … … … …                          24
Section 29       Safer Recruitment … … … … … … … …                              24
                 Guidelines pertaining to client contact     … … …              24
Section 31       Concerns regarding domestic violence in families …             26
Section 32       Guidelines for Pre Assessment Checklists (PAC)
                 previously known as Come to Notice or Form 78 …                27
Section 33       Additional guidance for record keeping in child
                 protection … … … … … … … … … …                                 28
Section 34       Transfer of records for children with a child protection
                 plan and vulnerable children general information …             32
Section 35       Child protection conferences      … … … … …                    34
Section 36       Guidance for managers, named nurse safeguarding
                 children/safeguarding children advisors and
                 professional heads of services … … … … …                       36
Section 37       Legal issues, requests for information and guidance            37
                 for completion of court reports … … … … …
Section 38       Child protection supervision … … … … … …                       39
Section 39       Child protection training and induction     … … …              44
Section 40       Guidance for GP and Trust medical staff … … …                  45
                 Acknowledgement                                                50




Version 3.   Page 4 of 80      Child Protection policy and procedure Sep 2008        4
                                            APPENDICES

                   Description                                                  Page No
Appendix 1         Safeguarding children team, social care and police –
                   contact details … … … … … … … … …                            50
Appendix 2         Allegations against staff – contact details                  51
Appendix 3         What to do if you’re worried a child is being abused. A
                   flowchart for referral … … … … … … …                         52
Appendix 4         Interagency referral form … … … … … …                        53
Appendix 5         Guidance for Independent Contractors when dealing
                   with allegations of child abuse against staff … …            64
Appendix 6         Guidance for General Practitioner when dealing with
                   allegations of child abuse against staff … … …               65
Appendix 7         Transfer out record for child protection/vulnerable
                   children/families … … … … … … … …                            66
Appendix 8         Report form for inter agency child protection
                   conference/meetings … … … … … … …                            68
Appendix 9         Legal guidance – flowchart … … … … … …                       70
Appendix 10        Safeguarding children supervision agreement …                71
Appendix 11        Clinical supervision record for safeguarding children/
                   child protection/ vulnerable families record … …             73
Appendix 12        NHS Brent Safeguarding arrangements chart …                  76
Appendix 13        Assurance Form for monitoring compliance with
                   Safeguarding Children Policy … … … … …                       77
Appendix 14        Equity Impact Assessment         … … … … …                   78
Appendix 15        References … … … … … … … … …                                 80




Version 3.   Page 5 of 80      Child Protection policy and procedure Sep 2008             5
1       Policy Aim

1.1     Policy and Procedure
        This aim of these updated policy and procedures for safeguarding children is to ensure
        all staff understand that safeguarding children is everyone’s responsibility. All staff
        working within health services have statutory duties and responsibilities to promote and
        protect the well-being of children within NHS Brent These policy and procedures set out
        how health staff and professionals within NHS Brent should work together to promote
        children’s welfare and protect them from abuse and neglect.

1.2     Scope
        This document applies to all staff directly employed NHS Brent and all independently
        contracted employed staff Involved in providing care to families.

1.3     Responsibility of all staff
        It is the responsibility of all staff who are employed, and independent contractors, to
        have read, understood and be in a position to act in accordance with the contents.

2       Introduction - Safeguarding Children is everyone’s responsibility.

2.1     Section 11 of the Children Act 2004 sets out the statutory guidance on making
        arrangements to safeguard and promote the welfare of children.

2.2     Every Child Matters (2003) aims to secure better outcomes for all children and young
        people so that they:
        Are healthy
        Stay safe
        Enjoy and achieve
        Make a positive contribution
        Achieve economic wellbeing
        www.everychildmatters.gov.uk

2.3     Child abuse occurs in a variety of circumstances and crosses social class barriers
        although research indicates those living in poverty and with high stress factors are
        frequently at greater risk. Health professionals are well placed to recognise when a
        parent or other adult has problems which may affect their capacity as a parent or carer,
        or which may mean they pose a risk of harm to a child. Staff should remember that their
        paramount duty at all times is to protect the child within the framework of the current
        legislation.

2.4     Due regard should be given to issues of race, culture, gender and disability when
        working with families to safeguard and promote children’s welfare.

2.5     This Policy/Procedure relates to work with families and children where there is identified
        risk of significant harm (child protection) as well as vulnerable families where children
        are identified as being 'in need'.




Version 3.   Page 6 of 80     Child Protection policy and procedure Sep 2008                      6
2.6     Under section 47 of The Children Act 1989, Child Protection relates to cases where a
        child is perceived to be suffering or be likely to suffer significant harm.

2.7     Under section 17 of the Act, the term Child in Need relates to vulnerable children and
        families who require increased family support without which a child/children's health,
        development and welfare may be compromised. These families and children, as for
        child protection, will require continuous assessment of risk / need and care plans aimed
        at minimising risk to the child.

2.8     The ongoing interagency assessment and focused work based on agreed care plans
        are fundamental to all work with vulnerable and child protection families.
        All London Safeguarding Children Boards (LSCB) including Brent LSCB have adopted
        the London Child Protection Procedures (2007) (LCPP)

3       National Policy, Legislation and Guidance

3.1     These procedures complement and are to be used alongside:
             What to do if you are worried a child is being abused DfES (2006): Every Child
              Matters – Change for Children (2006) DfES
             Please note that this guidance supersedes previous ‘Guidance to Doctors
              working with Child Protection Agencies’ and ‘Child Protection Guidance for senior
              nurses, health visitors, midwives and their managers’.
             Information Sharing: Practitioners ‘ guide. DfES London (2006)
             London Child Protection Procedures London Safeguarding Children Board (3rd
              Edition 2007)
             'Working Together to Safeguard Children' DfES, HM Gov (2006) (WT 2006)
              www.ecm.gov.uk/workingtogether
             'The Framework for Assessment for Children in Need and their Families' DoH,
              Home Office, D of E, (2000)
             The National Service Framework for Children, Young People and Maternity
              Services (NSF) 2004 – Standard 5 outlines the requirement for safeguarding and
              promoting the health and welfare of children and Young People

3.2     Supplementary guidance and procedures for safeguarding children

        There are additional policies detailing supplementary guidance from WT (2006) that are
        included in London Child Protection procedures: (2007)

        These include
             Safeguarding Children Involved in Prostitution DH (2000)
             Safeguarding Children in Whom Illness is Fabricated or Induced; DH (2008)
             Safeguarding Children from Abuse linked to a belief in Spirit Possession DfES
              (2006)

        Further supplementary procedures include
             Safeguarding Sexually Active Children.
             Safeguarding Children Abused through Sexual Exploitation.
             Safeguarding Trafficked and Exploited Children


Version 3.   Page 7 of 80    Child Protection policy and procedure Sep 2008                    7
                  Safeguarding Children missing from Care and Home.
                  Safeguarding Children missing from School.
                  Safeguarding Children through Domestic Violence.
                  Safeguarding Children through Female Genital Mutilation.

         There are numerous documents relating to safeguarding children referred to throughout
         this policy. Links/references have been provided to aid management of the extensive
         guidance available. All supplementary guidance is available on the publication and
         resource section of: www.everychildmatters.gov.uk
         The documents referred to in this policy are available on: -
         NHS Brent Intranet and Internet sites, via the safeguarding children web page.
         Brent Local Safeguarding Children Board http://www.brentlscb.org.uk/
         DCSF website www.everychildmatters.gov.uk
         London Safeguarding Children Board - LCPP (2007)
         http://www.londonscb.gov.uk/procedures/

         The safeguarding children team are familiar with this guidance; they are available to
         support any member of staff who has concerns about a child’s welfare, and will discuss
         and give specific advice regarding child protection and child welfare issues. Appendix 1.

4        Agency Roles

4.1      The shared responsibility of all agencies are highlighted in the LCPP (2007)
         All health service staff whether providing services to children or their parent / carer have
         a duty to:
         Consider the welfare of dependants and/or vulnerable children and give the needs of
         the children priority.
         Be alert to the possibility of child abuse and neglect.
         Recognise and act on indicators that a child’s welfare may be at risk.
         Be familiar with local procedures and national guidance for safeguarding children.
         Know how to access safeguarding children advisors and the named and designated
         professionals from whom advice can be sought.

5        Local arrangements to safeguard children

         Information detailing telephone / email contacts are disseminated to health
         professionals in NHS Brent. They are available on Brent Intranet and Internet or from
         NHS Brent Safeguarding Children Team. Appendix 1

5.1      The duties and responsibilities of the Safeguarding Children Team are outlined below
         S:\Child Services\CS_SFC\Policies\Updated Policy Information\Designated Named
         Professional and Advisors roles 08_.doc



  S:\Child Services\
CS_SFC\Policies\Policy 2008 version 2\Designated Named Professional and Advisors roles 08_ (2).doc




Version 3.     Page 8 of 80             Child Protection policy and procedure Sep 2008               8
5.2     Health Service staff includes:
             Community or school based doctors, nurses, health visitors and midwives
             Hospital medical, nursing and midwifery staff and radiographers
             Paediatricians
             General Practitioners (GPs) and attached practice nurses and ancillary staff
             Dentists and dental nurses and hygienists (further guidance is available from
              your professional organisation)
             All mental health medical and nursing staff
             All learning disability medical and nursing staff
             NHS Direct and walk-in centre medical and nursing staff
             Pharmacists (further guidance is available from your professional organisation)
             Family planning
             Child and Adolescent Mental Health Services (CAMHS)
             Women’s services
             Sexual Health Services
             Allied health professionals e.g. therapists, counsellors, clinical psychologists,
              psychoanalysts, family therapists, (further guidance is available from your
              professional organisation) administrative and clerical staff in clinics and practices
              and other health settings

6       All STAFF MUST FOLLOW SPECIFIC GUIDENCE OUTLINED IN LCPP (2007)

6.1     Requirements for all services working with children and families
        A copy of these Policies, Procedures and Guidance must be held in each base and all
        staff aware how to access them electronically. For areas without immediate access to
        computers, line managers must make arrangement for hard copies of this guidance to
        be available. The Intranet page will be updated as necessary.
              All staff must be familiar with the definitions for physical abuse, emotional and
               sexual abuse and neglect as in 'Working Together to Safeguard Children'. DfES,
               HM Gov (2006)
              Key staff working with children must access child protection supervision as
               specified and adhere to the child protection supervision guidelines.
              Staff have a duty to co-operate with relevant colleagues in Health, Children
               Social Care, and other agencies, where information is sought, or close working
               together is required between agencies to safeguard children.
              Disclosure of confidential information about clients should only take place with
               the consent of the individual involved. However, the safety of a child is
               paramount and information can be shared without the consent of the parent
               where the child is deemed to be at risk of significant harm.
              Staff must respect and be sensitive to the race, culture, gender and disability
               when assessing the care of children.
              Record keeping must be clear, accurate and contemporaneous.
              The safety and welfare of a child is paramount and over-rides all other
               considerations.




Version 3.   Page 9 of 80     Child Protection policy and procedure Sep 2008                      9
6.2     Relevant guidance and legislation
             Children Act, 1989 and 2004 (Chapter 12), Human Rights Act, 1998, Data
              Protection Act, 1998.
             The Caldicott Standards (applicable to Health and Social Services Departments)
             Information Sharing: Practitioners’ guide. DfES London (2006)

7       General Principles for Safeguarding Children for Health Professionals

        All health professionals who work with children and families should be able to:
              Understand the risk factors and recognise children in need of support and/or
               safeguarding.
              Recognise the needs of parents who may need extra help in bringing up their
               children and know where to refer for help.
              Recognise the risks of abuse to an unborn child.
              Contribute to enquires from other professionals about children and their family or
               carer.
              Liaise closely with other agencies, including other health professionals
              Assess the needs of children and the capacity of parents/carer to meet their
               children’s needs, including the needs of children who display sexually harmful
               behaviour.
              Plan and respond to the needs of children and their families, particularly those
               who are vulnerable.
              Contribute to child protection conferences, family group conferences and strategy
               discussions.
              Contribute to planning support for children at risk of significant harm, e.g. children
               living in households with domestic violence or parental substance misuse.
              Help ensure that children who have been abused and parents under stress (e.g.
               those who have mental health problems) have access to services to support
               them.
              Play an active part, through the child protection plan, in safeguarding children
               from significant harm.
              As part of generally safeguarding children and young people, provide ongoing
               promotional and preventative support through proactive work with families,
               families and expectant parents.
              Contribute to serious case reviews and the implementation of any
               recommendations.
               (WT (2006) Section. 2.34)

8       Working in partnership with families

        The aim of the child protection process is to ensure the safety and welfare of a child and
        the child's interests should always be paramount. Partnership does NOT always mean
        agreeing with parents or other adult family members.
              Treat all family members, as you would wish to be treated, with dignity and
               respect.




Version 3.   Page 10 of 80      Child Protection policy and procedure Sep 2008                    10
               Ensure that family members know that the child's safety and welfare must be
                given priority, but that each family member has a right to a courteous and
                professionally competent service.
               Take care not to infringe on privacy any more than is necessary to safeguard the
                welfare of the child.
               Be clear with yourself and with family members about your power to intervene,
                and the purpose of your professional involvement at each stage.
               Be aware of the effects on family members of the power you have as a
                professional, and the impact and implications of what you say and do.
               Respect the confidentiality of information given or observations made. Do not
                share this information with others without the subject's permission unless it is
                essential to do so to protect the child.
               Listen to the concerns of children and their families and take care to understand
                their perspective when undertaking your assessment.
               Learn about and consider children within their family relationships and
                communities, including their cultural and religious contexts, and their place within
                the family.
               Consider the strengths and potential of family members, as well as their
                weaknesses, problems and limitations.
               Ensure that children, families and other carer’s are aware of their responsibilities
                and rights, including their right to services, and their right to refuse services, and
                the possible consequences of refusal.
               Use plain, jargon-free language appropriate to the age and culture and
                understanding of each person. Explain any unavoidable technical and
                professional terms.
               Be open and honest about your concerns and responsibilities, plans and
                limitations.
               Allow children and families' time to take in and understand concerns and
                processes. A balance needs to be found between appropriate speed and the
                needs of people who may require extra time in which to communicate.
               Take care to distinguish between personal feelings, values, prejudices and
                beliefs and professional roles and responsibilities, and ensure that you have
                good supervision to check that you are doing so.
               If a mistake or misinterpretation has been made, or you are unable to keep to an
                agreement, provide an explanation.
               Always acknowledge any distress experienced by adults and children and do all
                you can to keep it to a minimum.

9       Common Assessment Framework – Every child matters - change for children

9.1     The Common Assessment Framework (CAF) provides a common method of
        assessment across children’s services; it facilitates early identification of need. LCPP
        (2007) Section 6.2 and www.everychildmatters.gov.uk




Version 3.   Page 11 of 80       Child Protection policy and procedure Sep 2008                     11
        It is designed for when
               There are concerns about how well a child is progressing in terms of their health,
                behaviour, progress in learning and any other aspect of their well-being.
               The child’s needs are unclear or broader than a single service can address.

9.2     A CAF should be completed when a professional has concerns that the child will not
        progress towards the five Every Child Matters priority outcomes (4:1)
             A common assessment framework should be completed prior to a referral to
              social care for Section 17 and 47 referrals.
             Where there is an immediate need for a child protection assessment and
              response, professionals should contract Brent Social Care directly and make a
              referral rather than completing a common assessment (see section 13)

10      Interagency meetings

10.1    These meetings consist of:
             Strategy meetings
             Child protection conferences
             Core group meetings
             Professional meetings

        Professional meetings - are meetings between agencies to discuss and share
        information where children are deemed to be in need, and to decide a plan of support
        and work aimed at safeguarding the welfare of the child/children in the family.
        Strategy meeting - normally held within 72 hours of an incident or allegation of abuse.
        Its purpose is to share information and to plan an investigation.
        These meetings will always involve Social Care and Police but may require attendance
        from another involved agency that has information to share, which will further inform the
        investigation.
        The child protection conference is central to the child protection process. It is a
        meeting between professionals involved with the family and family members, in order to
        exchange and share information and concerns, analyse risks and recommend a child
        protection plan of action, with delegated responsibilities.
              An initial child protection conference - follows a Section 47 enquiry (Children
               Act 1989) and where the enquiry concludes that a child/children may have
               suffered and/or be at risk of suffering / continuing to suffer significant harm.
               Initial Child Protection case conferences should take place within fifteen days of
               the strategy discussion.
               For a child protection conference to be quorate three member agencies Social
               Care, Health &/or Education and/or Police must be present.
              A review child protection conference is held within three months of an initial
               child protection conference and thereafter every six months until a child
               protection plan is no longer required.
              A Core Group Meeting is a meeting between key professionals (named in the
               child protection conference care plan) together with the parent/carers to discuss
               and progress the child protection plan. The first core group meeting is usually
               held six weeks after the case conference.



Version 3.   Page 12 of 80     Child Protection policy and procedure Sep 2008                   12
11      Communication, Confidentiality and Information Sharing

11.1    The importance of accurate, objective record keeping cannot be overstated.

11.2    All staff should be conversant and compliant with Brent Record Management and
        Information Sharing Policy as well as guidelines issued by professional bodies e.g. The
        General Medical Council, The Nursing and Midwifery Council and the other Health
        Professionals Councils.

11.3    The main sources of relevant law with respect to information sharing and confidentiality
        in child protection are the: -
               Common law duty of confidence
               European Convention on Human Rights (via its introduction into English law in
                the Human Rights Act 1998)
               Data protection Act 1998
               Children Act 1989 and 2004 Chapter 12
               The Caldicott Standards (applicable to Health and Social Services Departments)

11.4    In general the law does not prevent sharing of information with other practitioners if:
             Those likely to be affected consent
             The public interest in safeguarding a child’s welfare overrides the need to keep
              the information confidential
             Disclosure is required under a court order or other legal obligation.

11.5    Staff will need to consider each case on an individual basis to ensure that where explicit
        consent cannot be obtained the case meets one of the above criteria before information
        is passed onto another agency.
              If staff have a reasonable concern that a child is suffering or is at risk of suffering
               significant harm, they should pass on information to professionals to achieve the
               objective of protecting the child.
              The reason for passing information without explicit consent should be
               documented in the child/family records. “What to do if you are concerned about
               a child” (2006) gives guidance on information sharing, as does LCPP (2007)
               Appendix 4 page 533)

11.6    The disclosure of information should only take place:
             With the consent of the patient or client
             Without the consent of the client when disclosure is required by law or by order
              of the court
             Without the consent of the client when the disclosure is considered to be
              necessary in the public interest.

11.7    Information, which affects the welfare interests of the child, should be shared on a "need
        to know" basis with workers from agencies represented on Brent LSCB
        Information requested from health workers, by agencies represented on Brent LSCB, in
        connection with a child's welfare should receive a prompt and comprehensive verbal
        and written response.



Version 3.   Page 13 of 80      Child Protection policy and procedure Sep 2008                     13
11.8    Referrals to the appropriate agency (Social Care) should be made immediately child
        protection / child in need concerns are identified and the parents informed of and
        engaged, as far as possible, in understanding and accepting the need for the referral.

11.9    Staff who remain unsure of taking appropriate action should seek advice from the
        safeguarding children advisor / named or designated professionals. Named/designated
        professionals may seek further advice from Caldicott Guardian and/or the Trust
        Solicitor.

12      Information received from a member of the public expressing concerns about a
        child or an unborn baby

12.1    If a member of the public, staff or any other statutory or voluntary agency contacts any
        employee of Brent tPCT with information regarding possible abuse of a child or unborn
        baby they should be encouraged and supported to contact Social Care. The
        professional should always notify Social Care of the referral/information received.
        The professional who receives this information should gather as much information as
        possible to be able to make a judgment and a request for basic information i.e.
              Name, address, gender and date of birth of the child
              Name and contact details of the parent/carer, educational setting, GP or any
               known lead professional involved with the family.
              The informant should be asked if they are willing to give their name, they should
               be advised that you have a duty to pass on the information that you have given
               them.
              Members of the public have a right to remain anonymous, however no guarantee
               of confidentiality can be given, as there are certain limited circumstances in which
               the identity of a referrer may have to be given (e.g. the court arena)
              If the member of the public is reluctant to refer/give information. Alternative
               means of reporting concerns can be offered i.e. NSPCC Child Protection Helpline
               or Childline (appendix 1)
        Discuss the information received with their line manager/safeguarding children advisor
        and agree and record an action plan. LCPP (2007) Section 4.6

13      Request for legal reports
13.1
               Where there are legal implications in relation to communications, the matter
                should be discussed with the safeguarding children advisor / named or
                designated nurse or doctor.
               The interests of the child override any confidentiality between worker and adult
                client. The adult client should be informed of the worker's duty towards the child.
               Any difficulties with inter-agency or inter-disciplinary communication should be
                discussed with the safeguarding children advisor. If a resolution cannot be
                negotiated the safeguarding children advisor will discuss it with the
                named/designated nurse or doctor.
               NO information from child protection conferences should be shared outside Brent
                LSCB agencies unless with specific permission of the child protection conference
                chair. Should any such request be made the matter must be referred to the
                safeguarding children advisor /named /designated nurse or doctor.


Version 3.   Page 14 of 80      Child Protection policy and procedure Sep 2008                   14
               Solicitors, other than Local Authority Solicitors (Social Care Department), are not
                member agencies of the Brent LSCB. NO information should be given to them
                over the telephone or agreement given to supply information in writing on child
                protection matters. They should be advised to apply in writing to the designated
                nurse/doctor child protection. They will generally be referred to the LA solicitors
                or to the Children and Family Court Advisory and Support Service (CAFCASS).
                The practitioner should inform the designated nurse/doctor of such requests and
                forward any copies of correspondence.

13.2    Staff should be familiar with the Trust Policy and Procedure for Access to Health
        Records (Access to Health Records Act 1990). ALL written requests to see professional
        records received by staff should be discussed as soon as possible with the
        safeguarding children advisor / named or designated nurse and line manager.

14      Media Enquires

        If you are contacted by the media or involved with a child and family where there are
        child protection / child welfare concerns you should refer all requests to your line
        manager and/or designated professionals, who will seek further guidance/liaise with the
        Communication Department.

15      Consent

        Any child over the age of 16 years may legally consent to surgical, medical and dental
        treatment.

15.1    Unobtainable Consent
        In an acute life-threatening situation, the practitioner has a duty to make a professional
        judgment in the best interests of the 'patient' and to carry out any essential treatment to
        ameliorate the emergency.

15.2    Under 16 Years
             When a child who is under 16 years of age is seen unaccompanied, written
              consent should have been obtained from the parent. Routine surveillance and
              screening, which are part of the school health programme and are considered to
              be in the best interests of the child, do not require written consent.
             Written refusal must be respected except where there are issues of abuse or
              neglect, where this occurs, this situation should be discussed initially with the
              safeguarding children advisor or named/designated professionals for
              safeguarding children. The parent/carer should be informed that a referral has
              been made in the best interests of the child.
             A minor is entitled to consent to treatment if they are of sufficient maturity and
              intelligence to understand the nature of the proposed treatment and its
              ramifications. The decision of competence lies with the practitioner (Children Act
              1989, Family Law and Reform Act 1969 S 8).


Version 3.   Page 15 of 80      Child Protection policy and procedure Sep 2008                   15
               A child who has sufficient understanding to make an informed choice has the
                right to refuse to submit to examinations or treatment (Children Act 1989).

16      Parental Responsibility

               Parental consent may be given by either parent if married at the time of the birth
                of the child.
               If the parents are separated or divorced, both parents can give consent and be
                supplied with health information on the child. (unless the child objects)
               Single mothers and married couples automatically have parental responsibility for
                their children. Since December 2003, this has been extended to unmarried
                fathers if they are named on the birth certificate, either at registration of the birth
                or subsequently. Where the mother and father are not married, both must
                consent to the father being named on the certificate.

17      Data Protection Act 1998

        Requests to see professional records should be discussed with your line manager and
        the safeguarding children advisor named / designated professional for child protection.

18      Looked After Children

               When children are fostered or in residential care, the parent still has parental
                responsibility in conjunction with the Local Authority.
               In cases where a child is a looked after child the parent held record should
                remain with the child. In cases of adoption the receiving PCT should issue a new
                record.
               An authorised representative from the Local Authority (usually the Social Worker
                for the child) can give consent on behalf of the parents from whom consent has
                been obtained.
               When there is need for major surgery or treatment the parents consent should
                also be obtained.
               Children who are under 18 years old and are wards of court must have consent
                obtained from the court.

19      Recognition of child abuse and/or neglect

19.1    Working Together to Safeguard Children WT (2006) and the LCPP (2007) set out the
        definitions and examples of four broad categories of abuse, which are used for the
        purpose of developing a child protection plan to safeguard children.

19.2    Abuse and neglect are forms of maltreatment – a person may abuse or neglect a child
        by inflicting harm, or failing to act to prevent harm. Children and young people may be
        abused in a family or in an institutional or community setting; by those known to them or,
        more rarely, by a stranger. An adult or adults or another child or children may also be
        an abuser.




Version 3.   Page 16 of 80       Child Protection policy and procedure Sep 2008                     16
20      Definitions of abuse

20.1    Physical Abuse
        Physical abuse may involve hitting, shaking, throwing, poisoning, burning or scalding,
        drowning, suffocating, or otherwise causing physical harm to a child. Physical harm may
        also be caused when a parent or carer feigns the symptoms of, or deliberately induces
        illness in a child.

20.2    Emotional Abuse
        Emotional abuse is the persistent emotional maltreatment of a child such as to cause
        severe and persistent adverse effects on the child's emotional development. It may
        involve conveying to children that they are worthless or unloved, inadequate or valued
        only insofar as they meet the needs of another person. It may feature age or
        developmentally inappropriate expectations being imposed on children. These may
        include interactions that are beyond the child’s developmental capability, as well as
        overprotection and limitation of exploration and learning, or preventing the child
        participating in normal social interaction It may involve seeing or hearing the ill treatment
        of another. It may involve serious bullying, causing children frequently to feel frightened
        or in danger, or the exploitation or corruption of children. Some level of emotional abuse
        is involved in all types of ill treatment of a child, though it may occur alone.

20.3    Sexual Abuse
        Sexual abuse involves forcing or enticing a child or young person to take part in sexual
        activities, including prostitution, whether or not the child is aware what is happening.
        The activities may involve physical contact, including penetrative (e.g. rape or buggery)
        or non-penetrative acts. These may include non-contact activities, such as involving
        children in looking at, or in the production of, sexual on line images, watching sexual
        activities, or encouraging children to behave in sexually inappropriate ways.

20.4    Neglect
        Neglect is the persistent failure to meet a child's basic physical and/or psychological
        needs, likely to result in the serious impairment of the child's health or development.
        Neglect may occur during pregnancy as a result of maternal substance abuse. Once a
        child is born, neglect may involve a parent or carer failing to:
               provide adequate food, clothing and shelter (including exclusion from home or
                abandonment)
               protect a child from physical and emotional harm or danger,
               ensure adequate supervision (including the use of inadequate care-givers)
               ensure access to appropriate medical care or treatment.
               It may also include neglect of or unresponsiveness to, a child’s basic emotional
                needs. (What to do if you are worried a child is being abused: 1.29 – 1.33 (2006)
                DfES)

21      Children in specific circumstances who may be at risk of suffering neglect.

21.1    All staff working with children and families should be aware of the action to be taken if
        they have welfare concerns about a child in specific circumstances; these are included
        in LCPP (2007) Section 5


Version 3.   Page 17 of 80      Child Protection policy and procedure Sep 2008                    17
               Socially excluded / isolated children and families 5.1
               Animal abuse and links to abuse of children and vulnerable adults 5.2
               Begging 5.3
               Blood –borne viruses 5.4
               Boarding school 5.5
               Bullying 5.6
               Custodial; Settings for children 5.7
               Custodial settings (children visiting) 5.8
               Diplomats families 5.9
               Disabled children 5.10
               Domestic violence 5.11
               Fabricated or induced illness 5.12
               Female Genital Mutilation 5.13
               Firesetting 5.14
               Forced marriage of a child 5.15
               Foreign exchange visits 5.16
               Foster Care 5.17
               Harming others 5.18
               Historical abuse 5.19
               Honour based violence 5.20
               Hospitals 5.21
               Hospitals (specialist) 5.22
               Information and communication technology (ICT) based forms of abuse 5.23
               Left alone 5.24
               Male circumcision 5.25
               Missing families for whom there are concerns for children or unborn children 5.26
               Missing from care and home 5.27
               Not attending school 5.28
               Parental mental illness 5.29
               Parents with learning disabilities 5.30
               Parents who misuse substances 5.31
               Pregnancy and motherhood for a child 5.32
               Pre-trial therapy 5.33
               Private fostering 5.34
               Psychiatric care for children 5.35
               Psychiatric ward and facilities (children visiting) 5.36
               Residential care 5.37
               Self harming and suicidal behaviour 5.38
               Sexually active children 5.39
               Sexually exploited children 5.40
               Spirit possession or witchcraft 5.41
               Surrogacy 5.42
               Trafficked and exploited children 5.43
               Young carers 5.44




Version 3.   Page 18 of 80      Child Protection policy and procedure Sep 2008                18
21.2    Additional guidance
              Accessing information from abroad 5.45
              Criminal injuries compensation 5.46
              Working with interpreters / communication facilitators 5.47

21.3    Advice/support on these and other specific child protection issues should be requested
        from safeguarding children advisors/named or designated health professionals

22      Using the Framework for the Assessment of Children in Need and their Families
        (DOH 2000)

22.1    The framework provides a standardised approach to the referral and assessment
        process.
              It encourages a systematic multi-agency approach to analyse and record what is
               happening to children and young people within their families and the wider
               context of the community in which they live.
              All health services staff should be aware of the Assessment Framework, refer to
               it and apply it to the referral and assessment process.

22.2    The Assessment Framework triangle DOH (2000) is reproduced below. It highlights
        three domains.
              Children’s developmental needs
              Parents’/caregivers’ capacity to respond appropriately
              Impact of the wider family and environmental factors on parenting capacity and
               children




Version 3.   Page 19 of 80     Child Protection policy and procedure Sep 2008                   19
22.3     Referrals to Social Care
             Having made a preliminary assessment of the situation, if you have any concerns
              regarding possible child abuse or neglect, a referral must be made to Children
              Social Care. You must consider sharing the information with parents/guardians.
             There will be very few circumstances when it is inappropriate to do so. These
              include situations where you would physically endanger yourself or increase the
              risk of significant harm to a child e.g. sexual abuse cases, fabricated or induced
              illness.

22.4    The flow chart: ‘What to do if you are worried a child is being abused’ gives further
        guidance (appendix 4).
              The referral should be made promptly by telephone and followed up in writing
               within 24 hours, using the inter-agency referral form This should be faxed or sent
               to social care. A copy of the referral should be retained in the health records.
               (appendix 5)
              In cases of serious injury, medical attention must be sought immediately from
               Accident & Emergency Department. Children Social Care and the Duty
               Consultant Paediatrician must be informed as soon as possible.
              If a child is known to have an allocated social worker, the referral should be made
               to him/her, or in his/her absence, to the social worker’s manager.
              In other circumstances, the referral should be made to the appropriate Referral
               and Assessment Team of Children Social Care via the Call Centre (appendix 1).
              In urgent situations, out of office hours, the referral should be made to the
               Emergency Duty Team.
              Health staff working on school premises should liaise with the Child Protection
               Lead in the school prior to making a referral.
              The safeguarding children advisor/named/designated nurse for child protection
               may be consulted as appropriate before a referral and must be informed as soon
               as possible after referral. Medical staff may wish to consult with their designated
               or named professional (appendix 1).
              Named professionals will ensure that designated professionals are kept informed
               of serious child protection issues.
              A formal referral or any urgent medical treatment must not be delayed by the
               need for consultation.
              Except in cases where emergency treatment is required, Children Social Care
               and the police are responsible for ensuring that any medical examinations are
               initiated.
              Information about the referral should be shared with the GP, and other relevant
               professionals working with the family as appropriate.
              Sequence of events/concerns, action taken and subsequent plans should be
               recorded in the relevant child health and family records contemporaneously.

22.5    NB: Referral to Children Social Care may not be necessary if the explanation given is
        consistent with your findings. However, you must fully document your sequence of
        events, assessments, care plans, and your decision making process.




Version 3.   Page 20 of 80     Child Protection policy and procedure Sep 2008                   20
23      Actions in cases of sexual abuse (all clinicians)

23.1    Where there is an allegation of sexual abuse, or where you suspect sexual abuse, no
        further interviewing of the child or family should take place. You may wish to discuss the
        case with the Named /Designated Doctor for child protection.
              It is important that when a child makes an allegation of sexual abuse the child’s
               words should be recorded exactly as spoken.
              No leading questions should be asked.
              Immediately contact the local Social Care Department. Clearly state if it is known
               that the abuse is likely to have occurred within the last 72 hours. This will help a
               forensic investigation.
              Inform the Safeguarding children advisor as soon as possible and where
               appropriate the Designated Nurse / Doctor.
              Record accurately and contemporaneously observations, events and actions
               taken.
              Confirm your referral to Social Care in writing within 24 hours. Send a copy
               marked confidential to the safeguarding children advisor/named nurse, GP and
               retain a copy in the professional record.
              Where a fax is sent it must be marked confidential. The recipient should be
               contacted and advised that of the time the fax will be sent. A further telephone
               call should be made to confirm receipt.
              Attend interagency meetings and / or child protection conference as required.

23.2    If Children Social Care have not acknowledged, in writing, receipt of a referral within 3
        working days, the referrer should contact Children Social Care. The reasons for the
        delay in acknowledgement should be recorded. The safeguarding children advisor
        should be notified.

23.3    Referrals may lead to:-
             No further action;
             Directly to provision of services or help, Section 17; or
             A fuller assessment of needs and circumstances of the child which may, in turn,
              lead to Section 47 enquiries;
             Emergency action to safeguard the child

24      Allegations of Child Abuse against any individual Working with Children in NHS
        Brent

24.1    Covered in LCPP 2007 – refer to Section 15
             Where allegations of abuse are made against a staff member or volunteer,
              whether contemporary in nature, historical, or both, the matter should be referred
              to the Social Care, in the same way as any other concern about possible abuse.
              In addition the Local Authority Designated Office should be informed.
             The Senior Manager and Human Resource Manager responsible for managing
              this process must be informed. They will initiate the process for investigating this
              matter (appendix 2)
             Consideration should be given to contacting the designated doctor or nurse for
              child protection for advice and consultation.


Version 3.   Page 21 of 80     Child Protection policy and procedure Sep 2008                   21
24.2    It is essential that all allegations are examined objectively by staff who are independent
        of the service where the alleged abuser works.
               The Line Manager directly responsible for the member of staff should not attend
                the planning meeting, as it is not appropriate to involve them in planning how to
                investigate a staff member in which they will have involvement and be offering
                ongoing support. Arrangements should be made to have their views represented
                (unless, in exceptional circumstances, it is deemed inappropriate).
               It is important that when allegations are made early consideration is given to the
                distinction between an allegation and a complaint. Where doubt exists as to the
                nature of what is being referred, appropriate multi-agency consultation is
                essential so that the accuracy, transparency and integrity of the process are
                safeguarded and any doubt clarified.
               It has to be acknowledged that all staff may be vulnerable to malicious or
                mischievous allegations or complaints; therefore objectivity and a balanced
                approach to information received are essential. (appendix 5 & 6)

24.3    The investigation may have three related, but independent, strands:
             Child protection enquiries relating to the safety and welfare of any children who
              are, or who may have been, involved.
             A Police investigation into a possible offence.
             Disciplinary procedures where it appears that allegations may amount to
              misconduct or gross misconduct on the part of staff.

25      Children in whom illness is fabricated or induced

25.1    The procedure for this is laid out in the LCPP Section 5.12. In addition, the HM Gov
        supplementary guidance “Safeguarding Children in Whom Illness is Fabricated or
        Induced” (2008) Safeguarding Children in whom illness is fabricated or induced and,
        especially but not exclusively for paediatric staff, the Royal College of Paediatrics and
        Child Health (RCPCH) report “Fabricated or Induced Illness by Carers” (2002). This
        guidance is currently being updated to take account of WT (2006) and recent clinical
        developments.
        See additional information Duties of Doctors and Other Health Professionals in
        Investigations of Child Abuse 2007

25.2    There are three main ways of the carer fabricating or inducing illness in a child these are
        not mutually exclusive
             Fabrication of signs and symptoms. This may include fabrication of past medical
              history.
             Fabrication of signs and symptoms and falsification of hospital charts and
              records, and specimens of bodily fluids. This may include falsification of letters
              and documents.
             Induction of illness by a variety of means




Version 3.   Page 22 of 80     Child Protection policy and procedure Sep 2008                       22
26.     Child Deaths Review Processes WT (2006) Section 7

26.1    Covered in LLCP (2007) – refer to Chapter 12 for further guidance.
        Interim Procedures for Child Death Review Panels and Rapid response to child death
        are available on Brent Intranet via the safeguarding children page and on Brent LSCB
        website.

27      Procedures where there is death or serious harm to a child under the age of 18
        years.
27.1
               Inform the lead professionals for child death as outlined in LCPP (2007)
               Inform the Named/ Designated Doctor and Nurse, where there is a child
                death/serious injury of a vulnerable child or a child:-
               Who has a child protection plan.
               Who has a section 17 or 47 assessment in progress
               Who has been assessed by health as within a vulnerable family.
               Who has died or been injured as a result of a trauma or under suspicious
                circumstances.
               Who is accommodated
               Who is the subject of a court order.

27.2    The Designated Nurse/Doctor will inform:
              The Chief Executive
              The Director for Provider and Estates / Assistant Director with responsibility for
               children services.
              Director of Public Health
              The Community Paediatrician/Named Paediatric Consultant.
              Safeguarding Children Team
              Line Manager
              General Practitioner.
              Police and Social Care
              Communication Department
        Staff should refer all enquires thereafter to the designated professionals.

27.3    All health visitor / school nurse / community childrens nurse records / looked after
        children records / paediatric community records must be secured by the line manager
        immediately and arrangements made to deliver these to the Safeguarding Children
        Team within 24 hours of notification of the death or serious injury.
              The designated professionals will notify the chief executive of all subsequent
               investigation and legal actions
              The safeguarding children advisor/named/designated nurse child protection will
               accompany the professional to any initial/review child protection conference
               following a death or serious injury. The named/designated nurse/doctor child
               protection is available for advice/support at any stage of the proceedings.
              In the absence of the designated nurse, the named nurse/safeguarding children
               advisor will act as the designated nurse child protection.




Version 3.   Page 23 of 80     Child Protection policy and procedure Sep 2008                       23
28      Complex Abuse cases

28.1    Covered in LCPP (2007) – refer to Section 14 for further guidance.

29      Safer Recruitment

29.1    Covered in LCPP (2007) – refer to Section 17 for further guidance

30      Guidelines pertaining to client contact

30.1    Failed access on pre-arranged visits/appointments
              Where there are no access visits, leave a calling card with your name and
               contact address / telephone number, the time of your visit and inviting the client
               to contact you for another appointment.
              Document failed appointments in the professional record, including on the key
               incident sheet.
              If the parent/carer fails to contact you, formally write, reinforcing the missed
               appointment and offering another date, requesting the parent to contact if
               inconvenient.
              Always make sure your communications clearly state your name, base and
               telephone number.
              A copy of all communications should be retained/recorded in the records.
              Inform Social Care and GP of non-compliance where a child is vulnerable or is
               the subject of a child protection plan.
              Inform the safeguarding children advisor and line manager of all cases of non-
               compliance in order to discuss the appropriate action.

30.2    Repeated no access visits
            Where there are three failed appointments check all relevant agency contacts to
             ascertain whether the family still resides at the address.
            Where it appears that a family has moved to an unknown destination inform the
             designated nurse child protection so that a missing family memo can be
             circulated to all Trust bases. This applies to vulnerable families as well as those
             with children with a child protection plan.

30.3    Client refusal of Community NHS services
              Respect the right of the individual to refuse health services.
              Letter to be sent to client by professional involved in conjunction with line
               manager acknowledging refusal and informing of services and how to access
               them. A change of worker may be offered in certain circumstances (exception
               rather than the rule)
              Inform line manager / safeguarding children advisor, social worker and GP where
               there are welfare concerns for the child. This should be followed up in writing.
              An inter-agency professional meeting may need to be held.




Version 3.   Page 24 of 80     Child Protection policy and procedure Sep 2008                   24
30.4    The unseen child
        Practitioners should consider a child 'unseen' if they become aware that primary care is
        not being delivered to the child at home, in the child health clinic or in the GP surgery,
        other health settings or via a school setting.

30.5    Factors which alert possible child protection response
             a very young or vulnerable baby (e.g. pre-term, small baby)
             a previous or current history of child abuse or a child in need
             a history of mental health problems affecting a family member
             a sudden change in accessibility without explanation
             a family unable to establish working relations with professionals
             a family with frequent changes of address
             a family with a child/ren on the special needs register
             a history of repeated presentation at A&E departments
             a family history of violence
             information shared by another agency, e.g. non-attendance at appointments
             a 'looked after' child
             a family where drug/alcohol abuse is known/suspected
             see section 21 children in specific circumstances.

30.5     Action to be taken
              Discuss concerns with safeguarding children advisor / line manager and agree an
               action plan. This should be recorded in the professional record.
              Social Care, GP and any other agency involved with the family should be made
               aware of the non-compliance with all Health Services.
              An inter-agency meeting may be conferred to discuss and share information and
               concerns.

30.6    Missing children/families (Child protection/Children in need)
        Social Service circulation of missing families/children
              Check details of the family/children on CIS.
              If the family is identified, inform safeguarding children advisor/named/designated
               nurse immediately.
              Retain forms for one year and then shred.
              Check all new vulnerable families against these forms.

30.7     Families who have moved from your area to an unknown destination:
              Inform safeguarding children advisor/named nurse.
              Inform Social Care and GP
              Issue missing family circular (via Safeguarding Children Team) to all bases in
               Trust.
              If a homeless family, check with the placing authority
              Always document the placing authority of all families housed in homeless or
               temporary accommodation.




Version 3.   Page 25 of 80     Child Protection policy and procedure Sep 2008                   25
30.8 Children left alone
           When, on visiting a home, a member of the Trust's staff finds a child/ren left
            unattended or without adult supervision, the following action must be taken:
           Where a child is deemed to be in danger do not delay in calling the police and
            notifying social care.
           Do not enter the house.
           Attempt to establish the child's understanding of the whereabouts of the parent or
            responsible person and of the arrangements made.
           Remain at the house allowing a reasonable time for the return/response of the
            parent/carer. The maximum waiting time should be 30 minutes.
           When there is no evidence of an adult carer, alert the police and social care
            department.
           The age and developmental needs and circumstances of the child must always
            be considered when assessing the situation; these factors will inform your actions
            in relation to their vulnerability.
           Wait until the parent/carer police or social worker arrives before leaving.
           Where the parent/carer returns discuss with them the concerns for the children
            left alone and your responsibility to share these concerns with social care
            colleagues.
           Notify your line manager and safeguarding children advisor of the incident and
            actions that you have taken.
           Record the actions you have taken in the child’s record and complete any referral
            forms as necessary.

31      Concerns regarding domestic violence in families

        See section 3.2 for links to Safeguarding Children through Domestic Violence.
             The safety of the client/patient and any children is the paramount consideration in
              deciding on a particular intervention.
             Staff should be aware of the availability of support for women and children who
              are in situations of domestic violence.
             Try to see the patient/client alone and enquire if domestic violence is an issue.
             Listen to what they are saying and provide support and advice.
             Enable them to make informed choice about their situation, whether to seek help
              and/or refuge.
             Respect confidentiality, especially in ethnic minority communities and recognise
              the real dangers if this is breached.
             Use the skills and contributions which other agencies are able to make, and co-
              operate with them appropriately.
             If the children or others are considered to be in immediate danger from domestic
              violence, the police should be called.
             The risk to the child/ren should be assessed and referral to Social Care made
              where appropriate as per the referral procedure.




Version 3.   Page 26 of 80     Child Protection policy and procedure Sep 2008                 26
31.1     Violence towards staff
              Staff should never compromise their own safety
              It should be recognised that where there is violence towards staff the atmosphere
               of violence suggests greater risk of violence towards children. Aggression
               towards outside agencies blocks access and can shield abusive families from
               scrutiny.
              If a family is violent, all professionals who may visit the family, such as GP, social
               workers and others, should be notified by telephone and this confirmed in writing.
              If a parent/carer/family makes a threat of violence in your presence or on the
               telephone to you towards another professional/agency, notify the other
               professional/agency concerned immediately by telephone, confirmed in writing, to
               prevent any contact.
              Threats of violence made at meetings by parents/families towards an absent
               professional should be accurately recorded along with an action plan, which
               clearly states which professional present will take responsibility for immediately
               notifying the colleague who has been threatened.
              Where home visiting is deemed of too great a risk, Social Care and the
               safeguarding children advisor/named nurse and line manager should be
               informed. A strategy discussion should be held to formulate an action plan. The
               decision should be fully recorded in the notes. In this situation arrangements
               should be made for the child to be seen outside the home with appropriate
               security arrangements

31.2    If a visit is deemed essential, staff should:
                Visit the home with another colleague.
                Inform their line manager about the proposed time of the visit and duration.
                Inform staff at your base of the visit and ask them to alert your line manager if
                 you do not return to base or telephone in by an agreed time.
                Telephone your line manager and base to inform them that the visit was
                 completed safely.
                If a violent situation arises, staff must withdraw immediately and inform their line
                 manager/safeguarding children advisor and the service manager.
                Physical or verbal abuse towards staff must be reported in writing on an incident
                 report form.

32      Guidelines for Pre Assessment Checklists (PAC) previously known as Come to
        Notice or Form 78 (Community Staff)

32.1    PAC is the name given to the form used by the police to record any incidence they
        attends, where children (0-18 years) are present. These forms are sent to Social Care
        and relevant information sent to the Safeguarding Children Team (This information will
        be sent onto relevant line managers - via secure e-mail)
              Each form should be assessed, and an appropriate care plan developed for all
               children mentioned on the form. Consideration should be given to the following:
              The information received
              Is this new information?
              Is this the first PAC?



Version 3.   Page 27 of 80      Child Protection policy and procedure Sep 2008                     27
               Do you know the child/family?
               What other information do you have?
               If you do not know the child/family – Is this child/family a ‘transfer-in’?
               Have you already developed a care plan?
               Is this issue addressed in the care plan?
               Is the child/family known to Social Care? Or any other agencies?

32.2    What action needs to be taken?
             Do you need to make contact with the family?
             Following your assessment offer appropriate services
             Working together with the family, develop and document a care plan and action.
             Discuss with appropriate professionals if necessary e.g. GP, Social Worker,
              school.
             If there is not a Key Events sheet on the records, set one up
             Document receipt of PAC on the ‘Key Events’ sheet (date, action and outcome)
             PAC should be filed (in chronological order) and tagged to the child’s record.
             Where there are three PAC in the child’s record – the health visitor/school
              nurse/community children nurse must then assess the records and consider the
              most appropriate plan of action. These children and families should be discussed
              in supervision
             An interagency professional meeting may need to be held.

33      Additional Guidelines for Record Keeping in Child Protection
33.1
               These guidelines do not replace standards set by professional organisations but
                are complementary to them and should be used in conjunction with the Trusts
                Clinical Record Keeping Standards and Records Management Policy.
               All staff must carefully reflect on their ability to work within this policy’s
                framework. Staff must consult their line manager if they have difficulty following
                this guidance or have concerns about their ability to comply with the
                requirements.
               Good record keeping is an important part of the accountability of professionals to
                those who use their services. It helps to focus work and is essential to working
                effectively across agency and professional boundaries.
               Clear and accurate records ensure that there is a documented account of an
                agency’s or professional involvement with a child and/or family. They help with
                continuity when individual workers are unavailable or change, and they provide
                an essential tool for managers to monitor work or for peer review
               Records are an essential source of evidence for investigations and enquiries, and
                may also be required to be disclosed in court proceedings. WT (2006)
               ‘The quality of your record keeping is also a reflection of the standard of your
                professional practice. Good record keeping is a mark of the skilled and safe
                practitioner, whilst careless or incomplete record keeping often highlights wider
                problems with the individual’s practice’ Guidelines for records and record
                keeping, Nursing and Midwifery Council - NMC (2007)




Version 3.   Page 28 of 80       Child Protection policy and procedure Sep 2008                28
33.2     Responsibilities
             All practitioners are responsible for ensuring they comply with the NMC
              Guidelines for records and record keeping (2007), NHS Brent’s Clinical record
              keeping standards and Records management (2008)
             Brent Primary Care Trust policy on record management must be observed, that
              is:
             All contacts should be recorded as soon as is possible and practicable but within
              24 hours
             Each entry should record the date, time and be signed. The signature should be
              legible, and also printed. The designation of the post holder should be recorded
             Record entries in black ink which is readable when photocopied
             Parent-held personal child health record completed if available
             Notes should be kept chronologically
             All contacts, appointments and visits should be recorded including:
             Telephone contacts
             Non-attendance at appointments and “no access” visits
             Communications / discussions with other disciplines or agencies
             Referrals to other agencies, including non-uptake of referral with reason given

33.3    Telephone calls
       At the end of a telephone call relating to a child protection issue, summarise the content
        of the conversation and clarify the agreed plan of action. Record this accurately in the
        professional record.

33.4    Telephone messages
             ALL telephone messages taken for a colleague must be put in a message book
              or a duplicate-style book (or electronic equivalent) so that a record remains of
              receipt of the message.
             All messages should include the date, time and be signed by the person
              receiving the message.
             The person to whom the message is addressed should tick that it has been
              received, date and initial it.

33.5     Loose pieces of paper should not be placed in the records.
             The message should be written in the records with the time and date received.
             If duplicate sheets are used, the page should be secured within the notes as well
              as recorded in the health records.
             Non-permanent self –adhesive message pads (“Post-it” – style notes) are not to
              be used.
             Staff should use the appropriate transfer of records form for children with a child
              protection plan or vulnerable children. (appendix 7)
             Untoward incidents should be reported to the PCT using the incident reporting
              form.
             Additional guidance and support can be found in the tPCT’s Incident Reporting
              Policy and Risk management strategy.


Version 3.   Page 29 of 80     Child Protection policy and procedure Sep 2008                   29
33.6       Non-registered practitioners/staff
                All qualified clinical staff are professionally accountable for ensuring any duties
                 delegated to non–registered staff are completed to a reasonable standard.

33.7       Delegation of record keeping duties
                Where record keeping duties have been delegated, it is the responsibility of the
                 qualified healthcare professional to ensure that the person documenting in the
                 patient record is competent to perform the task and that there are process for the
                 regular review of the record and the raising of any identified concerns

33.8       Supervision of non-registered staff
                The qualified healthcare professional providing supervision is professionally
                 accountable for all entries and consequences arising from the patient health
                 record.
                Where duties have been supervised, the healthcare professional must ensure
                 that all entries in the health record have been countersigned.
                Guidelines on Code of conduct, Accountability, Consent and Confidentiality
                 (NMC 2008) Guidance on record keeping (NMC 2007)

33.9       Filing and Storage of records
                  Child protection records should not be filed separately from the main body of the
                   records.
                  The exception is for school health where the practice for is that these records of
                   children with a child protection plan are kept at the Trust clinic base with a tracer
                   card system in place for the filing cabinets in schools.
                  Records must be kept safe and secure at all times (in line with NHS Brent
                   records management policy)

33.10 Organisation of child protection files in NHS Brent
           Family card should be filed in front the folder (applicable for health visiting)
           Tracer cards should be used to cross reference different surnames in filing
            cabinets.
           Family record should be used as a book with additional record sheets filed inside.
           File child protection conference reports and minutes together in record
           File medical information together e.g. A&E attendances, hospital letters and other
            health reports

33.11 Minimum dataset for safeguarding children
          It is essential that the following basic information is recorded and checked for
           accuracy at each contact1
          Name, address, date of birth
          NHS number *
          GP
          School/ Nursery
1
    Laming report 2002 ( *not part of Laming recommendations)



Version 3.     Page 30 of 80            Child Protection policy and procedure Sep 2008                 30
               Siblings
               Details of carer/parents.
               Open packages of care/ reason for enhanced service highlighted
               Details of children with a child protection plan
               Parental responsibility for each child.
               Private fostering arrangements
               Any legal order in place. e.g. Interim Care Orders

33.12 Entries into Clients Records
            Records must be structured to reflect a care plan and should include:
            Purpose of any contact
            Assessment/evaluation of the client and/or situation
            Carer’s interactions with child and health professional
            Identification of any risks or concerns
            Actions taken/advice given.
            The planned outcome of the contact.
            If a referral is made the service must be specified not merely noted as a location
            Review date or plan of future action.
            Failure to keep appointments and no access visits must be recorded
            Make reference to receipt of reports in child’s records eg speech and
             language/therapy report.

33.13 Abbreviations, ambiguity and jargon
          Records should not contain ambiguous statements. For example “OK today” may
           give a vague picture but not enough information if a new practitioner intervenes.
          Records should not contain subjective statements such as “odd looking child” or
           “acting strangely”.
          Observations and “intuitive knowing” should be underpinned with more accurate
           information about what was seen/ heard to form that conclusion.
          If unusual professional jargon is used, this should be explained in lay terms.
          Entries made by others
          Practitioners are accountable for the entries made by other staff or students
           under their supervision including child care advisors and health visiting
           assistants.
          It is important that the practitioner who is accountable should countersign
           records.

33.14 Children with a child protection plan
           The child protection plan for each individual child must be summarised and
            recorded on the child health record after each child protection conference.
            Outcomes of core group meetings or child protection supervision should also be
            recorded in the child’s record.
           Following a child protection conference if child/siblings are not subject to a child
            protection plan it is important that this decision is recorded in the child health
            record.




Version 3.   Page 31 of 80     Child Protection policy and procedure Sep 2008                  31
               Details of the child protection conference should also be recorded in the family
                record highlighting any key issues in relation to broader family issues and
                parenting. (Relevant for health visiting)

33.15 Use of Key Events Sheet
          A chronology of significant events should be recorded on a key events sheet for
           children with a child protection plan or children where there are emerging
           concerns.
          Entries should be cross referenced from main record and include for example,
           attendance at accident and emergency, change of address and failure to attend
           appointments.
          The key events sheet is helpful in providing a summary for handover to
           professionals or accompanying a referral to Children Social Care and is an
           important tool to aid report writing.

34      Transfer of Records for children with a child protection plan and vulnerable
        children general information (applicable for transfers within the PCT and outside)
             As soon as change of information is received i.e. children moving out of the area,
              change of address, GP or school; provide a verbal handover to the receiving
              practitioner- check local procedure for transfers out of the Trust as many areas
              send and receive records via the safeguarding children team. Include details of
              this verbal handover on the transfer of records form.
             Inform any other heath professional/allied health workers, the GP, your line
              manager and safeguarding children advisor of the change in information.
             If the change of details did not come directly from the allocated Social Worker,
              ensure that they are informed of any changes.
             Complete the Trust transfer of records form, providing a written summery of the
              current child protection plan for the child and family. Send this to the new health
              visitor/school nurse.
             Send the records with a copy of the Transfer of Records form to safeguarding
              children advisor at Wembley Centre for Health and Care. They will ensure that
              the records are transferred out within 48 hours, by recorded delivery.
             Ensure records are in chronological order with no loose papers or post it notes.
             Conference reports and minutes should be included.
             Transfer records within five days of receipt of information that child/children have
              moved or changed school/GP
             Update CIS and birth book/ school list
             Retain the family record if children are not living with parent/s e.g. children
              accommodated. This should be filed in the permanent archive file
             All records should be taken to the safeguarding children team office
              Tamper proof envelopes should be used to transfer records securely.
              Records will be sent via recorded delivery and a request made for confirmation of
              receipt of records by the safeguarding children team




Version 3.   Page 32 of 80      Child Protection policy and procedure Sep 2008                     32
34.1     Transferring records within the Trust
              Records should NOT be sent in the Internal Mail system. All records should be
               transported via the Safeguarding Children Team. Records should be taken to the
               line manager for allocation.
              You need to arrange a handover to the relevant staff member. If you are unable
               to achieve this please discuss with your line manager.
              Complete the Trust transfer of records form, providing a written summary of the
               current child protection plan for the child and family. Send this to the new health
               visitor/school nurse and a copy to the safeguarding children team
              In the unlikely event of a request for the urgent transfer of records, contact and
               discuss with your line manager/named/designated nurse and a courier will be
               arranged if appropriate.

34.2     Transferring records outside of the Trust
              All records should be taken to the safeguarding children team office
              Tamper proof envelopes should be used to transfer records securely.
              Records will be sent via recorded delivery and a request made for confirmation of
               receipt of records by the safeguarding children team.

34.3     Procedures for children/ families where the are issues relating to neighbourhood
        boundaries (for Health visitors) Currently under discussion
             Where a family is registered with a GP but lives outside the normal practice
              boundary’s neighbourhood, but within NHS Brent area, the GP attached health
              professional may discuss and agree with her colleague in the client’s
              neighbourhood to pass on the care of the family/child.
             The GP and social worker/safeguarding children advisor/named nurse child
              protection should then be informed of the agreed named health visitor.

34.3     Brent (LAC) Looked-after children fostered within Brent area.
              Children who are looked-after and placed with foster carers are usually registered
               with the foster carers’ GP.
              These children are to remain with their previous health visitor until the decision
               on the children’s permanent placement is reached. Their health visitor can have
               an arrangement with her colleague (foster carer’s health visitor) on weighing the
               child at the GP’s surgery or local clinic. However, assessment and report writing
               for conference, or court statement will rest with the child’s health visitor.
              The exception to this is where babies are placed directly from the Maternity Unit
               and there is no immediate intention of reuniting them with their birth parents, or
               children placed by other Local Authority boroughs. The health visitor for the
               foster carers takes full responsibility for the care/needs of this child.
              The GP and social worker/safeguarding children advisor /named nurse child
               protection, Child Health Computer Department and the named health visitor
               should be informed of any changes.

34.4 Children with a child protection/child in need plan and vulnerable children removed
     from a GP list
           The existing health visitor must retain responsibility until proof of registration with
            a new GP is obtained and the new health visitor and social worker are informed.


Version 3.   Page 33 of 80     Child Protection policy and procedure Sep 2008                    33
34.5    Children with a child protection plan transferring into Brent Area
        (For health visitors, school nurses and community children nurses)
              On receiving a verbal handover from the previous health professional
              Advise him/her to send the records via the named/designated nurse child
               protection via the Safeguarding Children Team at Wembley Centre for Health
               and Care.
              Inform and discuss as necessary relevant details with the safeguarding children
               advisor /named nurse and plan to see the child/family within one week of
               notification.
              Ensure the child’s details are entered in the birth book and on the CIS system.
              When the child’s records are received it is important to read the complete file.

        Liaise with Social Care Services for the following information:
              Name and contact details of the key worker
              Date of the next child protection conference

        At contact with the child/family:
              Health needs assessment should be undertaken in line with the assessment
               framework and reflect the current child protection plan
              Discuss again with a safeguarding children advisor:
              available health and social data.
              level and outcome of previous assessment.
              age of child/ren.
              wishes of the child/family.
              Clarify the health action plan
              Liaise with the new family GP and other professionals as necessary
              Organise a date for supervision
              Ensure all action is documented

35      Child Protection Conferences
             All staff should attend child protection conferences as a priority area of their work
              with children and families.
             Any member of staff who is unable to attend a child protection conference must
              discuss this with their line manager in the first instance. Child protection
              conferences must take priority over other commitments such as study days,
              general meetings etc.
             If non-attendance is unavoidable arrangements must be made for a colleague to
              attend, the replacement professional must be well briefed prior to attendance and
              have your reports and the child’s health record available for reference if
              necessary.
             Advise the safeguarding children team of the arrangements made.
             If it is impossible for yourself or a replacement to attend the child protection
              conference, the chair of the conference and the social worker must be informed
              immediately so that, if necessary, an alternative date for the conference can be
              made.



Version 3.   Page 34 of 80     Child Protection policy and procedure Sep 2008                   34
35.1    Support at child protection conferences
        Will be available;
              Via the line manager/experienced colleague/safeguarding children advisor where
               a key member of staff is newly qualified, returned to practice or has not
               previously had experience of child protection conferences.
              The case is particularly complex
              Following discussion with the line manager and practitioner that additional
               support is required.
              An initial or review child protection conferences where additional health expertise
               is indicated.
              Members of the safeguarding children team will attend in all cases of serious
               injury, death of a child or when the child protection conference concerns a
               member of staff.

35.2    Child protection conference reports - Key Principles
              It is a requirement that a health report is provided for all conferences, both initial
               and review conferences. The health report should provide an overview of the
               child/family from a health perspective. LCPP (2007); WT (2006).
              The report needs to be typed and presented using the PCT conference template.
              Ensure that the information in your report is accurate, that any statements are
               evidenced or substantiated, and that the source of the information is clear.
              Do not use abbreviations, and remember to use language that is meaningful for
               parents and non-health professionals.
              If there are sections in the report where you have no information or are unable to
               comment, please make it clear that this is the case, and give the reason why.
              Ensure that your report is discussed with a safeguarding children advisor
               Supervisor before sharing with the parents or outside agencies. Remember, your
               report may be submitted to court as part of the conference minutes.
              The information in the report needs to be shared with the parents before the
               report is submitted to Children Services, Social Care.
              Child protection conference reports need to be submitted to Children Services
               one day prior to initial conference (if possible) and three days prior to review
               conferences.
              At the end of a child protection conference if you note any errors on the report
               you have provided, inform the conference chair that you wish to resubmit a
               corrected copy.

35.3    Guidance on completing Child Protection Conference Reports
        Basic Information
             Ensure you indicate whether it is an initial conference or detail the number of this
              review conference i.e. 3rd or 4th meeting.
             Provide information regarding the reason for conference.
        Growth
             Ensure it is clear when the last measurements were taken and the relevant
              centiles.
             It is important to put the child’s growth into perspective (i.e. consistent with
              previous measurements).



Version 3.   Page 35 of 80      Child Protection policy and procedure Sep 2008                    35
             Where there are concerns regarding a child’s growth it would be appropriate to
              include a copy of the child’s centile chart.
        Medical history
             For initial conferences it is important to provide historical information (i.e. was the
              child premature, early hospital admissions).
             For review conferences it is important to provide updated medical information
              since the initial conference.
        Observations
             Evidence any observation of the child’s presentation or interaction with others.
        Development
             For initial conferences please include historical developmental information.
             It is important to evidence the child’s development (i.e. you need to comment on
              the developmental level that they have currently achieved).
        Recommendations
             Please comment on what needs to change or has changed in relation to the
              concerns within the family (eg x needs to live in a safe environment and not to be
              exposed to any further domestic violence; or for mother to engage with mental
              health services).
        Health Plan
             Include a child health care plan to meet the child’s assessed health needs.
        Parenting
             Ensure your comments are substantiated, and that all relevant information is
              included.
             Health Visiting/School Nurse/Community nursing contacts
             Ensure you provide information regarding attempted / failed/ declined contact, as
              this is evidence of the family’s engagement with you.
             Include historical contacts for initial conferences. For review conferences the
              original report can be referred to, with the dates covered by the current report,
              include updated information since the previous conference.
             (Appendix 8)

36      Guidance for Managers, Named Nurse Safeguarding Children / Safeguarding
        Children Advisors and Professional Heads of Services

36.1    It is the responsibility of managers and professional heads of services to
                Ensure service provision to vulnerable children and their families and where there
                 are child protection issues.
                All managers should attend PCT training and Brent LSCB safeguarding training
                 to ensure they are competent in issues concerning safeguarding children.
                In line with the Trust training needs analysis, identify safeguarding training needs
                 for all staff at PDR and submit information to the Learning and Development
                 team
                All staff should be familiar with the Trust Child Protection Policies and
                 Procedures (2008) and LCPP (2007). Managers should ensure that out of date
                 policies and procedures are removed from work areas.
                Refer any child protection legal matter immediately to the Safeguarding Children
                 Team



Version 3.   Page 36 of 80      Child Protection policy and procedure Sep 2008                    36
               Work in conjunction with members of the Safeguarding Children Team in respect
                of any issues of poor professional practice.
               Notify the safeguarding children team of any changes in establishment.
               Monitor that all staff are aware of their role and responsibilities for safeguarding
                children, complete the policy assurance monitoring record, and ensure that this is
                available for audit purposes Appendix 13

36.2    Support for child protection work
        With reference to the Trust Child Protection Policies and Procedures (2008), Managers
        should enable staff to prioritise child protection work by addressing the following:
              Identifying appropriate staff resources for specific areas of vulnerability, within the
               neighbourhood e.g. homeless families accommodation.
              Allocating cases requiring named professionals (e.g. school health advisor and
               health visitor), particularly during staff vacancies.
              Allowing time for child protection conference preparation, and report writing.
              Assist in arranging cover to allow staff to attend child protection conference.
              Assist staff in preparation of legal reports by providing administrative and clerical
               support.
              Supporting staff during interviews by Police, guardian-ad-litems, and legal
               representatives.
              Offering support for court appearances.
              Supporting staff during internal and serious case reviews and enquiries in cases
               of serious injury to, or death of, a child.
              Identifying training needs of staff and supporting attendance at study days.
              Data collection, audit, and evaluation around child protection work.

36.3    Agency staff
        Agency health visitors and school nurses and other key professionals will not normally
        hold responsibility for families whose children are subject to a child protection plan or
        families where there are high level concerns which would be deemed vulnerable and
        brought to child protection supervision for discussion.

        Exceptions may be made where a health visitor/school nurse who has been recently
        employed by NHS Brent returns to work in the Trust via an agency or in cases where a
        health visitor/school nurse has worked for an extended period of time on the same
        caseload. Agreement for this health visitor/school nurse to hold a defined workload,
        which includes vulnerable and child protection families will be made in consultation with
        the line manager/safeguarding children advisor.

        Agency nurses holding vulnerable and child protection cases will be supervised on a
        monthly basis and their competency monitored and reviewed by the safeguarding
        children advisor.

37      Legal Issues, Requests for Information and Guidance for completion of Court
        Reports

37.1    Staff should consult with the named nurse about ALL legal matters relating to families
        where there are child protection concerns. Line managers must also be informed.


Version 3.   Page 37 of 80      Child Protection policy and procedure Sep 2008                     37
             All requests for information, reports or statements must be submitted in writing to
              the designated /named nurse/Dr. If clinicians are contacted directly, they should
              inform the designated/ named nurse/Dr. as soon as possible.
             For children involved in care proceedings all requests from parents or their
              solicitors’ should be directed to the relevant Local Authority Legal Department so
              that there is a final common pathway for information flow between the Courts and
              NHS Brent.
             For criminal cases, the same principle applies except that the request should be
              directed via the Crown Prosecution Service.
             Requests for information may be made directly to medical staff.
             Police investigating a crime may need to make their request by telephone, as an
              urgent response is required. They should be asked to send a fax to a secure
              point of contact requesting this information.
             All requests should be discussed with the designated/named nurse. Staff will be
              supported in the writing of all reports/statements and attending required
              interviews.
             Staff should be familiar with NHS Brent Access to Records Policy. This is
              particularly important if the parent does not normally reside with the child or does
              not have parental responsibility.
             An external legal advisor is available if necessary and may be accessed through
              the designated/doctor nurse.
        (See section 11 on information sharing)

37.2    Attendance at court
              In many cases where court proceedings are pursued to safeguard children, a
               health professional may not be required to attend court at the time of the
               proceedings as the prepared report or statement may be submitted and accepted
               as sufficient to inform the Court.
              Should the local authority; or the police call an individual to attend court to give
               evidence, the evidence given should be as a professional; based on the
               information given in the statement previously submitted.
              Practitioners who have involvement with the family as part of their service will be
               appearing as ‘professional witnesses’.
              If the Court intends to use a practitioner as an ‘Expert Witness’ this should be
               agreed beforehand.
              Practitioners must be clear as to their witness status before giving evidence.
               Expert witnesses are not usually otherwise involved in the care of the child or
               family and the provision of expert witnesses is not a PCT function.
        (Legal guidance flowchart - appendix 9)

37.3    Writing a statement for court
              All the available records should be read and referred to.
              The statement should be written in uncomplicated language and should be clear
               and comprehensive.
              Statements should be factual; that is, based on what was said, heard, observed
               and done.




Version 3.   Page 38 of 80     Child Protection policy and procedure Sep 2008                   38
37.4    Format of Report for Family Law Proceedings
            State your name and position.
            Give the name of your employer and the year employment commenced.
            Give the name and address of the clinic/base from which you normally work.
            State your professional qualifications and year of qualification.
            State who has requested that you prepare the report, and nature of the
             proceedings.
            State the name and address of the family and children who are the subject of the
             report, giving the relationship between the adults and children and dates of birth.
            Give the details of your first contact with the child and family, e.g. “I first became
             involved with the family/children in ....”.
            State where seen, who was there, what was observed, professional assessment
             and any action taken. Ensure your assessment is within your own professional
             limits.
            State your concerns
            Key events/incidents must be written up in full detail.
            No access visits or non-attendance at appointments and the follow-up action you
             took should be recorded.
            Non-contentious routine entries in records can be summarised in the following
             style: “Between 01.09.06 and 10.10.07, home visits continued and no concerns
             were identified”.
            If the family have been known to a service for a long time it may be necessary to
             include information recorded by previous colleagues. The statement should
             clearly identify that this is information recorded by others.
            The report should be consistent with the records and each fact must be
             identifiable within the records.
            The main body of the statement will be a series of numbered and dated
             paragraphs summarising the corresponding entry in your records. This will make
             the statement clearer, particularly if it is a lengthy document. Dates and times of
             home visits/other contacts should be recorded with a brief summary of what
             happened, what was observed on each occasion and the action plan.
            The final paragraph should be a brief statement of professional opinion, which
             should be clearly differentiated as such. Unsubstantiated opinions or
             assumptions must not be included as fact.
            The statement should be typed with double spacing. Names and dates should
             be in bold type
            The final statement should be signed and dated. Before signing the final
             statement you should consider the content carefully with the named/designated
             nurse and make amendments as necessary. An external legal advisor is
             available and may be accessed if necessary in consultation with the designated
             doctor/nurse child protection.
            A copy of the final signed statement should be retained for your own reference.
             The named/designated nurse child protection will send the statement to the
             appropriate solicitor and provide a copy for the safeguarding children
             advisor/named professionals for safeguarding children.




Version 3.   Page 39 of 80     Child Protection policy and procedure Sep 2008                   39
38      Child protection supervision

38.1    For all staff working in Universal Children Services
               Safeguarding and promoting the welfare of children and protecting them from
                significant harm is an integral part of services provided in NHS Brent. For staff
                who have key responsibilities providing universal and targeted services to
                children and families, the provision of formal ongoing child protection supervision
                is essential. This ensures that the safety and welfare of the most vulnerable
                children are subject to continuing, assessment, evaluation, monitoring and
                review.
               NHS Brent expects all employees to access and fully engage in child protection
                supervision as the organisation holds vicarious liability for the employee’s
                actions.

38.2    “Working to ensure children are protected from harm requires:
             Sound professional judgments to be made. It is demanding work that can be
              distressing and stressful.
             For many practitioners involved in day-to-day work with children and families,
              effective supervision is important to promote good standards of practice and
              support for individual staff members.
             Supervision should help to ensure that practice is soundly based and consistent
              with Brent LSCB and NHS Brent child protection procedures.
             It should ensure that practitioners fully understand their roles, responsibilities and
              the scope of their professional discretion and authority.
             It should also help to identify the learning and development needs of
              practitioners, so that each has the skills to provide an effective service in line with
              competencies for safeguarding children.
             Supervision should include reflecting on, scrutinising and evaluating the work
              carried out.
             Supervisors should be available to practitioners as an important source of advice
              and expertise, and may be required to endorse judgments at certain key points in
              time. Supervisors should also record key decisions within the child’s case
              records”. WT (2006)
             Where a key health professional is clear that they have no child protection
              concerns on their caseload, supervisions sessions should be used to reflect upon
              and discuss families /situations which have the potential to become abusive.

38.3    Functions of Supervision
             The functions of child protection supervision can be summarised as
             Organisational – competent, accountable child centered practice and the
              safeguarding of standards.
             Professional – continuing education and the further development of knowledge
              and skills.
             Personal – support and recognition of the stresses created by child protection
              work.




Version 3.   Page 40 of 80      Child Protection policy and procedure Sep 2008                    40
38.4    Process of Supervision
             Supervision is a formal process with the primary purpose of safeguarding
              children identified as being at risk by:
             undertaking an assessment of risk and formulating a child centered protection
              plan.
             Monitoring the progress of the plan and reviewing and evaluating it.
             (Supervisory agreement - Appendix 11)

38.5    The supervisee has responsibility for:
             Bringing to supervision the records of families where there are unresolved child
              protection/child welfare issues.
             Considering in advance their assessments, plans and current level of
              involvement with each child and family.
             Ensuring that the child protection plans agreed during supervision are recorded in
              the child’s record, adhered to, targets set are realistic and in line with any agreed
              multi-agency child protection plan.
             Responding to, and acting on the key issues identified in supervision.

38.6    The supervisor has responsibility for:
             Reviewing the health records and actions agreed at the previous supervision
             Providing objectivity and critical analysis
             Providing support and constructive feedback
             Understanding and engaging, with the strengths, differences, values and feelings
              of the supervisee.
             Ensuring there are effective links between management and child protection
              supervision

38.7    The supervisee and supervisor have joint responsibility for:
             Ensuring that learning and development needs are considered in relation to
              safeguarding children and that training is accessed in line with NHS Brent
              mandatory training requirements.
             Ensuring that relevant policies and procedures are being used to inform practice.
             Ensuring that practitioners are working in partnership with children (where
              appropriate) carers and families.
             Working in partnership with other agencies and disciplines.

38.8    Line Managers have responsibilities for:
            Ensuring that staff have access to child protection supervision and support
             prioritising attendance at planned sessions.
            Agreeing appropriate number of supervisees with any child protection supervisor
             they manage.
            Dealing promptly and appropriately with any issues brought to their attention
             following child protection supervision.
            Inform supervisor of any managerial issues that may impact on practice of
             supervisee.




Version 3.   Page 41 of 80     Child Protection policy and procedure Sep 2008                   41
38.9    Frequency of child protection supervision
             School nurses and staff nurses should access supervision on a termly basis.
             Health visitors and community children nurses should access supervision three
              monthly.
             Newly qualified staff or staff who are new to role should have access to monthly
              supervision (group or 1:1) once they have responsibility for cases of vulnerable
              children. After 6 months the frequency of supervision should be reassessed with
              a view to the staff member, receiving 3 monthly / termly supervision if it is agreed
              by supervisor and supervisee.
             Staff who are members of the school nursing or health visiting teams but who do
              not hold responsibilities for child protection cases should access group
              supervision on a 3 monthly basis.
             All clinicians should seek ad hoc supervision as and when required. Record all
              such supervision with the safeguarding child advisor/named nurse child
              protection in the child’s record along with the agreed action plan.
             Agreed increase in supervision because a practitioner requires additional support
              (excluding newly qualified/new in role) should be time limited and the action plan
              reviewed in conjunction with the line manager.
             It is the responsibility of individual practitioners to ensure they arrange dates for
              supervision with their supervisor.
             It is recommended that sessions last no longer than 2 hours.
             Supervision session should be held between 10:00 and 12:00 and 14:00 – 16:00
              hours to facilitate workload management.

38.10 Advice from supervisors should also be sought when:
           New concerns for child welfare arise within a family
           There are significant changes in a priority family’s circumstances
           Referral is made to Social Services, Social Care Team
           If a referral to Social Services is not acted on/responded to
           If there are communication difficulties with other agencies
           If the Health Service is refused by a child/family and the child’s welfare is
            negatively compromised
           When access is not gained to priority families where there are child protection
            concerns
           When families where there are child protection concerns fail to attend
            appointments
           If there is a risk of violence towards a member of staff from the child or family

38.11 Identification of cases for supervision.

        The examples given below do not constitute an exhaustive list of risk factors but provide
        practitioners with a guide in identifying cases, which are part of their caseload that
        would be brought to supervision.
               Children subject of a child protection plan.
               Children who have been subject of a child protection conference since previous
                supervision.




Version 3.   Page 42 of 80     Child Protection policy and procedure Sep 2008                   42
               Children who are the subject of a child in need plan. (or who have been in the
                previous three months)
               Concerns about parenting capacity.
               Families where there is unresolved domestic violence.
               Families where substance misuse or mental health issues are impacting on
                Children.
               Parents with a learning disability of poor physical health which impacts on
                Children.
               Families who are hostile or aggressive to professionals including where there is
                difficulty gaining access to the Children.
               Historical concerns of abusive/neglectful parenting/previous children removed
                from parental care
               Concern for unborn babies
               Children with disabilities where there is concern about relationship with parent/s.
               Children disclosing abuse.
               Children where there is non attendance at school or nursery
               Children who are vulnerable because of their “risky behaviour”.
               Children who are looked by the LA.
               No access to children when there are identified safeguarding or child welfare
                concerns.
               The supervisee and supervisor should agree if a case no longer reaches
                threshold for supervision. This should by signed and dated by both parties.

38.12 Documentation
         The outcome of supervision should be recorded in the children health record and
          signed by both supervisee and supervisor, at the completion of the case
          discussion.
         The supervisor will check that a key event has been generated in the records.
         The supervisor will maintain a separate copy of the supervision record as an aide
          memoir, which contains basic details of the children and family and key points
          from supervision.
         If a family transfers within the PCT and there is a change of health professional
          and supervisor, the supervision record will be transferred to the new supervisor.
         When the children are no longer the subject of discussion in supervision, the
          supervision record can be destroyed as the information duplicates what has been
          recorded in the child health record.
         Other issues discussed in supervision i.e. training needs, should be recorded on
          a general supervision record, signed by both supervisee and supervisor. The
          supervisor and supervisee should keep a copy of this. This should be discussed
          during 1:1 with the line manager.
         When supervision is sought opportunistically by a practitioner (e.g. telephone
          consultation) the key issues and actions agreed should be recorded in the
          records by the supervisee. It is important that the supervisor/or professional
          providing ad hoc advice also records the key issues and plan and forward this to
          the supervisee for retention in the children records, a copy should also be
          retained in the practitioners supervision file. When the children are no longer the



Version 3.   Page 43 of 80      Child Protection policy and procedure Sep 2008                   43
               subject of discussion in supervision, this supervision record can be destroyed as
               the information duplicates what has been recorded in the child health record.
              The named or designated nurse will also request data in relation to supervision
               for audit purposes.
        (Clinical supervision record - Appendix 11)

38.13 Difficulties in supervisory relationship
            A supervisee wishing to change their supervisor should initially discuss the
             reasons with their supervisor wherever possible.
            If there are difficulties in the supervisory relationship that the supervisor and
             supervisee cannot resolve the respective line managers should be informed.
            Agreed actions should be recorded in the practitioners supervision file

39      Child Protection Induction and Training

39.1    Induction
        ALL new members of staff should attend the induction session for NHS Brent; child
        protection is a mandatory part of this course. It is the responsibility of the appropriate
        line manager to ensure that this happens.
        Training needs should be identified and agreed at the personal development review,
        and monitored by the line manager. The Learning and Development Team will provide
        training needs analysis.
        All health visitors, school nurses, specialist nurses who work directly with children and
        community children nurses should attend an induction session with a safeguarding
        children advisor before assuming case responsibility for children with a child protection
        plan. This should take place within the first month of employment.
              Induction will include
              Introduction to Trust child protection procedures, processes and documentation
              Introduction and familiarisation with the Local Authority child protection
               procedures, training and contact numbers
              Awareness of current legislation and guidance for safeguarding children.
              Awareness of the roles and responsibilities of the safeguarding children advisors
               and named/designated doctors and nurses, and how to access child protection
               advise when required.
              A safeguarding children training and development plan for staff members, this will
               include arrangements and timescales to attend Trust safeguarding children
               awareness sessions and Brent LSCB interagency training. This will be discussed
               with the line manager.
              Signing of safeguarding children supervision agreement.
              Agreeing first date for supervision.

39.2    Training
        The heads of every discipline working with children and families should ensure that their
        staff have received child protection training, appropriate to their need (see NHS Brent
        Child Protection Training Policy - Draft).

39.3    Trust induction session
        ALL staff to attend a safeguarding induction session (held monthly)


Version 3.   Page 44 of 80     Child Protection policy and procedure Sep 2008                    44
39.4    Single agency child protection awareness.
              A half a day child protection session for all staff working with children and families
               should be accessed within 6 months of employment.
              A half a day child protection session for all staff working with indirectly children
               and families should be accessed within 6 months of employment. e.g Ancillary
               staff, District nurses, Women’s Services, Therapy Services, Substance misuse
               teams, front of house administration staff. If you are in doubt about your
               requirements for safeguarding training please discuss with your line manager and
               contact a safeguarding children advisor.

39.5    Brent LSCB Interagency Training – accessed via Brent LSCB (appendix 1)
              Working together to safeguard children level 1.
              All staff who work with children and families should access this training where
               their work involves them in direct contact with children and families.
              Working together to safeguard children level 2
              After the completion of level 1 training All staff who work with children and
               families should access this training where their work involves them in direct
               contact with children and families.

39.6    Specialist training
        Brent LSCB provides a number of specialist courses – details of these are on Brent
        LSCB website. Attendance at these should be part of a personal development plan.

39.7    Launch of new/ amended child protection policies and procedures
        Short sessions are available when new policy guidance adopted.

39.8    Brent LSCB Conferences
        Held yearly – linked to local issues

39.9    Maintaining competencies for safeguarding
        All staff working with child protection cases are responsible for ensuring that they attend
        the mandatory minimum of 1 day of child protection training and undertake further
        learning and developmental activity each year. Staff who are closely involved with
        “Priority” families where there are child protection concerns should also receive more in-
        depth or specific training as identified during child protection clinical supervision / their
        personal development reviews

39.10 ALL staff not working with child protection cases should attend the trust refresher
      programme or revisit the basic child protection training available locally every 3 years to
      ensure they keep up-to-date with changes in legislation, Department of Health guidance
      and current research findings that underpin “best practice” in child protection.

40      Guidance for GP and PCT Medical Staff

40.1    Please refer to NHS Brent Child Protection Policy and Procedures (2008) and London
        Safeguarding Board child protection procedures (2007) which outlines all health
        professionals roles and responsibilities


Version 3.   Page 45 of 80      Child Protection policy and procedure Sep 2008                    45
40.2    Contact Details for Safeguarding Child Team – see appendix 1

40.3    What to do if you are worried a child is being abused DfES (2006): Every Child Matters
        – Change for Children (2006) DfES

        Please note that this guidance supersedes previous ‘Guidance to Doctors working with
        Child Protection Agencies’ and ‘Child Protection Guidance for senior nurses, health
        visitors, midwives and their managers’. London Child Protection Procedures Section
        2.1155 (2007)

40.4    In cases of extreme risk of harm
        Contact the Police and/or Children Social Care Department immediately.

40.5    In cases where serious injuries need urgent medical attention
        Contact hospital A&E dept. and advise sending case of possible child abuse.
        Inform the on call Paediatric Consultant of referral.
        Refer to Social Care and the police child protection team.

40.6    In cases of suspicion of child abuse or neglect
              It is advisable to discuss the case with other members of practice team, attached
               health visitor/school Nurse or other relevant health professionals involved.
              You may wish to discuss the case with a safeguarding children advisor/named or
               designated doctor or nurse before discussing further with the parent/carer.
              You can contact a social worker to discuss your concerns before making a formal
               referral.
              Seek to discuss your concerns with the child as appropriate to their age and
               understanding
              Advise parent of concern and if possible gain consent for referral, unless you
               consider such a discussion would place the child at risk of significant harm.
              If no consent given, advise parent of professional responsibility to do so in the
               interests of the child.
              Refer to Social Care using interagency referral form. (appendix 4)
              If there is the possibility of pressure being put upon the child by a parent/others to
               retract an allegation, or discussion with parent could place the child at increased
               risk, then the case should always be discussed with Social Care prior to
               discussion with the parent.

40.7    ACTIONS IN CASES OF SEXUAL ABUSE (ALL CLINICIANS)

        Where there is an allegation of sexual abuse, or where you suspect sexual abuse, no
        further interviewing of the child or family should take place. You may wish to discuss the
        case with the Named /Designated Doctor for child protection.
              It is important that when a child makes an allegation of sexual abuse the child’s
               words should be recorded exactly as spoken.
              No leading questions should be asked.




Version 3.   Page 46 of 80      Child Protection policy and procedure Sep 2008                    46
               Immediately contact the local Social Care Department. Clearly state if it is known
                that the abuse is likely to have occurred within the last 72 hours. This will help a
                forensic investigation.
               Inform the Safeguarding children advisor as soon as possible and where
                appropriate the Designated Nurse / Doctor.
               Record accurately and contemporaneously observations, events and actions
                taken.
               Confirm your referral to Social Care in writing within 24 hours. Send a copy
                marked confidential to the safeguarding children advisor/named nurse, GP and
                retain a copy in the professional record.
               Where a fax is sent it must be marked confidential. The recipient should be
                contacted and advised that of the time the fax will be sent. A further telephone
                call should be made to confirm receipt.
               Attend interagency meetings and / or child protection conference as required.

40.8    In all cases
               When making referral by telephone always ask for details you have given to be
                read back to confirm accuracy. Agree with the recipient of the referral what the
                child and parents will be told, by whom and when
               Follow up in writing (fax and hard copy) within 48 hours
               Make accurate contemporaneous notes of history, examination and actions
                taken. Also record all concerns, discussions about the child, decisions made, and
                the reasons for those decisions.
               It is helpful for multidisciplinary management, if cases involving children resident
                in Brent are referred to North West London Hospital Trust wherever possible.

40.9    Children in whom illness is fabricated or induced
        The procedure for this is laid out in the LCPP Section 5.12. In addition, the HM Gov
        supplementary guidance “Safeguarding Children in Whom Illness is Fabricated or
        Induced” (2008), Safeguarding Children in whom illness is fabricated or induced see
        section 3.38- 3.42, for the role of the GP, the primary health care team, practice
        employed staff and school nurses and, especially but not exclusively for paediatric staff,
        the Royal College of Paediatrics and Child Health (RCPCH) report “Fabricated or
        Induced Illness by Carers” (2002). This guidance is currently being updated to take
        account of WT (2006) and recent clinical developments.

40.10 There are three main ways of the carer fabricating or inducing illness in a child these are
      not mutually exclusive
           Fabrication of signs and symptoms. This may include fabrication of past medical
            history.
           Fabrication of signs and symptoms and falsification of hospital charts and
            records, and specimens of bodily fluids. This may include falsification of letters
            and documents.
           Induction of illness by a variety of means

40.11 See Joint statement by DFSF and DH on the Duties of Doctors and Other Health
      Professionals in Investigations of Child Abuse Duties of Doctors and Other Health
      Professionals in Investigations of Child Abuse 2007


Version 3.   Page 47 of 80      Child Protection policy and procedure Sep 2008                    47
40.12 Practice communication
      It is advisable that health professionals within the practice discuss cases. Where
      possible this should take place before a referral is made, so that accurate information
      can be obtained. Advice from the named GP, named/designated /doctor/nurse for child
      protection is also available.

40.13 Information sharing
      Sharing of information amongst practitioners working with children and their families is
      essential. In many cases it is only when information from a range of sources is put
      together that a child can be seen to be in need or at risk of significant harm.

40.14 Legal Restrictions
      There are legal restrictions in place, however the law will not prevent you from sharing
      information with other practitioners if the public interest in safeguarding the child’s
      welfare overrides the need to keep the information confidential.

.




Version 3.   Page 48 of 80    Child Protection policy and procedure Sep 2008                 48
ACKNOWLEDGEMENT

With thanks to Hammersmith and Fulham tPCTfor permission to use Legal Guidance Flowchart
(Appendix 9) and to their designated nurse for sharing a framework for clinical supervision.




Version 3.   Page 49 of 80   Child Protection policy and procedure Sep 2008               49
 Appendix 1
           SAFEGUARDING CHILDREN TEAM – Brent tPCT : CONTACT DETAILS
 The Brent Safeguarding Children Team is based at Barham House Wembley
 Centre for Health & Care, 116 Chaplin Road, Wembley HA0 4UZ consists of:-
     Interim Safeguarding Children       Tel: 020 8795 6397
 Administrator: Child Protection:        Fax 020 8795 6398
     Angela de Sousa                     Email: Safeguarding
                                         Childrenadmin@brentpct.nhs.uk
                                         Secure e-mail via nhs.net mailbox
                                         Bre-pct.safeguardingadmin@nhs.net

       Safeguarding children advisors      Tel 020 8795 7497 / 07768831463
       Liz Reid until 30.09.08             Email: Liz.Reid@brenpct.nhs.uk
       Joyce Mcleary                       Email: Joyce.Mcleary@brentpct.nhs.uk
       Vacancy
       Named Nurse for Safeguarding        Tel 020 8795 6389 / 07768831461
       Children from 1.10.08               Email: Liz.Reid@brenpct.nhs.uk
       Liz Reid
       Paediatric Liaison Nurse            Tel 020 8453 2779 / 07785562189
       Lucie Nkwocha                       Email: Lucie.Nkwocha@brentpct.nhs.uk
       Designated Nurse                    Tel: 020 8795 6396/Mobile:077 6883 1465
       Child Protection                    Email: Bernadette.Halford@brentpct.nhs.uk
       Bernadette Halford
       Interim Designated Doctor for
       Safeguarding Children               Tel 020 8795 6341 / 07786981106
       Dr Arlene Boroda                    Email: Arlene.Boroda@nwlh.nhs.uk
       GP with Special interest            Tel: 020 8795 6397
       Dr Dharmesh Shah                    Email: D.Shah@nhs.net

       CONTACT TELEPHONE NUMBERS FOR/BRENT SOCIAL CARE & THE POLICE

   SOCIAL CARE CHILD AND FAMILIES TEAM – BRENT
All referrals to - One Stop Shop        Tel 020 8937 4300
Duty Team Number – open cases           Tel 020 8937 4875/4587
Out of hours Emergency Duty Team        Tel 020 8863 5250
Fax                                     Tel 020 8937 4703/4839
Emergency Fax                           Tel 020 8937 4059

 and bank holidays)

 POLICE
 Brent Child Abuse Investigation Team          0208 246 1951
                                               Out of hours: 01895 251212
 Public Protection Desk                        0208 733 3752

 NSPCC                                          0808 8005000 www.nspcc.or.uk
 ChildLine                                      0800 1111 www.childline.org.uk


 Version 3.   Page 50 of 80   Child Protection policy and procedure Sep 2008           50
Brent Local Safeguarding Board      0208 9374237
Appendix 2
Where there are allegations against Staff
Contact Numbers for Brent LA/PCT - Senior Officers.


Name                         Position                       Contact details
Jean Cooper                  Local Authority                0208 937 3139
                             Designated Officer
Euston Copeland              Brent Local Safeguarding       0208 937 4299
                             Child Board Coordinator
Jane Busby                   Senior Manager Human           0208 795 7459
                             Resources
Dr Jim Connelly              Interim Director of Public     0208 795 6748
                             Health
Anita Underwood              Interim Assistant Director     0208 795 7442
                             Children Services
Arlene Baroda                Interim Designated             07786981106
                             Doctor for Child
                             Protection
Bernadette Halford           Designated Nurse for           0208 795 6396
                             Child Protection               07768831465




Version 3.   Page 51 of 80    Child Protection policy and procedure Sep 2008   51
Appendix 3




Version 3.   Page 52 of 80   Child Protection policy and procedure Sep 2008   52
                    Appendix 4
                    Referral and Information Record

                    The Referral and Information Record gathers together the essential information about a child
                    or young person. There is an expectation that within one working day of a referral being
                    received there will be a decision about what response is required (paragraph 3.8, Framework for
                    the Assessment of Children in Need and their Families, 2000).
A re-referral is     CSSR Case Number ______________________________________________________
defined as a         Date referral received:                                      Is the parent/carer aware of the
referral about
                     referral? Yes  No 
the same
child/young          Is this a re-referral?      Yes       No 
person within
                     If Yes, does the reason for the re-referral indicate that the response
twelve months
of a previous        to the original referral did not appropriately address the client’s needs
referral to the
                     Yes  No 
same council
(where the case
is closed).
                    CHILD/YOUNG PERSON’S DETAILS
Please record all    Family name _______________________ Given names _________________________
names the child
                     DoB or expected date of delivery:
and
parents/carers       Gender:                     Male      Female      Unborn 
have been
                     Address _______________________________________________________________
known by.
                     Postcode _____________________                   Tel. _______________________________
This is the
child/young
                     Child/young person’s first language or preferred means of communication ____________
person’s usual
or home              Is an interpreter/signer required?                 Yes       No
address. Where
                     Current address if different from above: ______________________________________
the parents
have shared          Postcode _____________________                   Tel. _______________________________
care, the
child/young          Social Services Team _____________________________________________________
person may
                     Responsible CSSR ________________________________________________________
have two
addresses.

Responsible CSSR
should be
completed if a
referral is being
made regarding
a child/young


     Version 3.     Page 53 of 80             Child Protection policy and procedure Sep 2008                     53
person who is
the
responsibility of
an authority
other than your
own. For
example, a
child/young
person on the
Child
Protection
Register in
another
authority or
looked after by
another
authority.

If the               Child/young person’s main carers:
child/young
                     Name                    Relationship to        Ethnicity              First language Parental
person’s main
                                             child/young person                                     Responsibility
carers are users
of social            _________________ _________________ ___________ ___________ Yes                         No
services, for
                     _________________ _________________ ___________ ___________ Yes                         No
example, if they
are known to         Is an interpreter/signer required?             Mother: Yes       No           Father:
adult social
                             Yes     No
services, their
Social Services      Other main carers (please specify name) _____________________________________
Case Numbers
                             Yes     No
should be
recorded.            Are any of the main carers disabled?           Mother: Yes       No            Father:
                             Yes     No
                     Other main carers (please specify name) _____________________________________
                             Yes     No
                     If known to Social Services – name of main carer, name of CSSR and Case Number
                      ______________________________________________________________________



Please record        Reason for referral/request for services:
brief details
about the
reason for
referral, or
services
requested by or


     Version 3.     Page 54 of 80         Child Protection policy and procedure Sep 2008                          54
on behalf of the
child. It is
important to
record details
even when
services cannot
be provided
immediately or
at all.
                    Referred by ___________________________Agency/rel.            to     child/young     person
                    ______________________
                    Address ____________________________________________________________Tel:
                    __________________________
                    Does the referrer wish to remain anonymous?          Yes       No

                   CHILD/YOUNG PERSON’S ETHNICITY
The                   Black or      Asian or    White                            Mixed           Other Ethnic
child/young         Black British Asian British                                                    Groups
person or the
child’s parents Caribbean          Indian            White British      White &            Chinese     
should be asked                                                            Black Caribbean
which ethnic    African            Pakistani         White Irish        White &            Any other 
group the child                                                            Black African       ethnic group
belongs to.     Any other          Bangladeshi       Any                White & Asian      Not given 
                Black                                  White
This            background                             background
information on                      Any other                             Any other       If other, please
ethnicity will                      Asian                                  Mixed background specify:
enable local                        background                                              _____________
authorities to                                                                              __
complete




    Version 3.     Page 55 of 80      Child Protection policy and procedure Sep 2008                       55
statistical
returns e.g.         Further details regarding child/young person’s ethnicity ________________________
SSDA 903
return, child in
need census.         Child/young person’s religion____________________________________________

In some
circumstances,
local authorities
may wish to
record more
specific
information
about a
child/young
person’s
ethnicity to
assist in service
provision. This
should be
recorded at
Further details
regarding.


EU citizens are
not required to                       Child/young person’s nationality (if not British):
register with the
                  Nationality __________________________ Home Office registration number _______
Home Office.
                  Immigration status: Asylum seeking       Refugee status                Exceptional leave to
                  remain


                                                  Parent’s details if not main carers:
                     Mother’s name ___________________           CSSR Case Number, if appropriate _________
                     Mother’s address __________________________________________________________
                     _____________________________________Postcode                     ______________      Tel.
                     ________________________
                     Mother’s first language ___________________Mother’s                               ethnicity
                     ____________________________________

                     Father’s name ___________________________ CSSR Case Number, if appropriate
                     ____________________
                     Father’s address ___________________________________________________________
                     _____________________________________Postcode            ______________        Tel.
                     ________________________
                     Father’s first language ___________________ Father’s                       ethnicity
                     _____________________________________


     Version 3.     Page 56 of 80      Child Protection policy and procedure Sep 2008                      56
                    Does father have parental responsibility?             Yes     No
                    Is either parent disabled?             Mother         Yes     No                 Father
                    Yes       No
                    Is an interpreter/signer required?     Mother         Yes     No                 Father
                    Yes       No


This section        Other household members (including non-family members):
records all
                       Family       Given name        DoB        If known to     Relationship     Tick if also
children/young
                       name                                         Social         to child        referred to
people and
                                                                   Services-                    Social Services
adults living at
                                                                  CSSR and                      at same time as
the
                                                                case number                           child
child/young
person’s usual
or home              __________     __________      _______         _________    ___________          
address.                  _              _
                     __________     __________      _______         _________    ___________          
If another                _              _
child/young          __________     __________      _______         _________    ___________          
person in the             _              _
household is         __________     __________      _______         _________    ___________          
being referred            _              _
to social            __________     __________      _______         _________    ___________          
services, please          _              _
tick in the box.
A separate
Referral and
Information
Record should
be completed
for each child
referred.

                    CHILD/YOUNG PERSON AND FAMILY NETWORKS
                         Significant family members who are not members of the child’s household:


                     Name _______________________       Name ______________________________
                     Relationship ___________________   Relationship __________________________
                     Address ___________________________ ___________________________________
                     Address ____________________________________
                      _____________________________      ___________________________________
                     Postcode _________ Tel.__________  Postcode       _____________          Tel.
                     ___________________




    Version 3.     Page 57 of 80       Child Protection policy and procedure Sep 2008                         57
In some cases it     Other Social Services cases associated with the child/young person:
is important to
record links to      Name _________________________           CSSR and Case No. ______________________
other Social
Services             Name _________________________           CSSR and Case No. ______________________
department
cases. For
example, where
half or
stepsiblings are
looked after by
an authority or
have had their
names placed on
an authority’s
Child Protection
Register.




    Version 3.     Page 58 of 80      Child Protection policy and procedure Sep 2008                58
The name of key
professionals     Key Agencies:                                 Tick if parental consent
from all agencies        Date consent
currently
involved with the                                                   to contact obtained
child and family
should be
recorded. This     G.P. Name __________________________________         
includes agencies
working with
parents.                        G.P. Address ________________________________

Parental              __________________                 Postcode ______________    Tel.
permission to         _____________________________
contact other
agencies should        H.V. Name _________________________________                    
be obtained
unless
permission                             H.V. Address _______________________________
seeking may
itself place a          __________________                                   Postcode _____________         Tel.
child at increased                                   ____________________________
risk of significant
harm (Paragraph        Nursery/School Name _________________________                  
5.6, Working                                                                       Nursery/School Address
Together).
                                       ______________________
It should be          __________________                 Postcode _____________     Tel.
ascertained
whether other         ____________________________
professionals
agree to the          Other Agencies (please specify):
information they       Name _____________________________________                     
are asked to
provide being
shared with the                        Address ___________________________________
child and/or
family.




     Version 3.    Page 59 of 80          Child Protection policy and procedure Sep 2008                       59
               __________________           Postcode ____________          Tel.
               ____________________________
                Name ____________________________________                  


                             Address __________________________________
               __________________           Postcode ____________          Tel.
               ____________________________
                 Name ____________________________________                 


                             Address ___________________________________
               __________________          Postcode _____________        Tel.
               ____________________________




Version 3.   Page 60 of 80     Child Protection policy and procedure Sep 2008     60
                      FURTHER DETAILS ABOUT THE CHILD/YOUNG PERSON AND FAMILY
If the child is
disabled, please       Child/young person: Disabled
record the type        The child/young person referred is disabled                         Yes     No
of impairment,
using the              The child/young person referred is on a disability register         Yes     No
children in need
census codes for
disability, on the
Initial
Assessment
Record (if this
information is
known).

The Child
Protection                         Child/young person: Child protection
Registration
categories set out
in Working             The child/young person referred is on the                           Yes     No
Together (1999)        child protection register of another CSSR
are Physical
Abuse, Sexual          The child/young person referred has                                 Yes     No
Abuse,                 been registered previously by any CSSR
Emotional
Abuse and
Neglect. These
categories are
different from
the previous
Working Together
(1991)
Please record all      Name of CSSR:                     Date of registration:             Date of de-registration:
episodes of the
child’s name           Category:
being on the
child protection
register.


Where child                      Child/young person: Looked after
welfare concerns
are raised about a                                                               Yes               No
child who is        Is the child/young person referred looked after by another
looked after, the CSSR?
CSSR where the                                                                   Yes               No
child is living has Child/young person referred has been looked after previously


     Version 3.      Page 61 of 80        Child Protection policy and procedure Sep 2008                              61
responsibility for by any CSSR
the child’s safety
and welfare until
that
responsibility is
transferred to the
responsible
CSSR.
Please record all Name of CSSR:                       Start date:                        End date:
episodes of the
child being
looked after.

Consent should     Relevant information:
be obtained from
relevant family    Other child(ren)/ young person(s) in the family is/has been                    Yes    No
members before     on a child protection register
recording this     Please give details, including name(s) and date(s)
information.
                    Name    ___________________            ____________________            ____________________

                            Date of registration           Date of registration            Date of registration


                            Date of de-registration        Date of de-registration         Date of de-registration


                   Other child(ren)/young person(s) in the family(s) is/has been looked after by a CSSR
                   Name     ___________________            ____________________            ____________________
                                                                                           _

                            Start date:                    Start date:                     Start date:


                            End date:                      End date:                       End date:




    Version 3.   Page 62 of 80          Child Protection policy and procedure Sep 2008                               62
 If a decision on
 the
 referral/request         Further action:                    Practice note: ensure this referral is collated with
 for services was
 not made within                                          previous referrals or files
 one working
 day, please
 explain why.         Provision of information and advice                                           Referral to
                               other agencies
                      Initial assessment                                        (please specify):
                      (to be completed within 7 working days)                   _____________________________
                      No further action
                      Referrer informed of action taken       Yes          No
 Where
                      If no, when will this be done
 appropriate the
 child/young
                      Parent’s informed of action taken:          Yes         No
 person should
 be informed of
                      If no, when will this be done
 the action taken
 following a          Child/Young Person informed of action taken:            Yes           No
 referral.            If no, when will this be done
                      Other action(s) (please specify):




                      Reason(s) for action(s) taken:



Name of social worker _______________________ Signature: ______________ Date:



Name of team manager ______________________ Signature: ______________ Date:




     Version 3.     Page 63 of 80          Child Protection policy and procedure Sep 2008                           63
Appendix 5             Guidance for Independant Contractors
                       Dealing with allegations of child abuse against staff




Version 3.   Page 64 of 80     Child Protection policy and procedure Sep 2008   64
Appendix 6             Guidance for General Practitioners
                       Dealing with allegations of child abuse against staff




Version 3.   Page 65 of 80     Child Protection policy and procedure Sep 2008   65
Appendix 7


Brent
                                       Teaching Primary Care Trust


                   CP Vulnerable Families / transfer out form
Health visiting / School Nursing
Child Protection / Vulnerable Families / Transfer Out (External / Internal)

FROM:                                                         TO:



DESIGNATION:                                         DESIGNATION:
BASE:                                                 BASE:


TEL.NO:                                               TEL.NO:
SCHOOL:                                               SCHOOL:



FAMILY NAME(S):
ADDRESS:                                              NEW ADDRESS:




POSTCODE:                                             POSTCODE:


 NAME – all family members     RELATIONSHIP          SEX         D.O.B        CATEGORY OF
                                                                                  RISK




Version 3.   Page 66 of 80   Child Protection policy and procedure Sep 2008                 66
PREVIOUS SOCIAL WORKER:
TEL.NO:
PREVIOUS G.P:
ADDRESS:

BACKGROUND SUMMARY / PRESENT SITUATION INCLUDING CHILDCARE
ARRANGEMENTS, LEGAL STATUS AND ANY OUTSTANDING HEALTH NEEDS




FULL ADDRESS OF WHERE TO BE SENT IF DIFFERENT FROM ABOVE:




DATE CIS AMENDED:                                 NOTIFIED VERBALLY TO:
                                                    ON:

SIGNED:                                                           DATE:

N.B.
For the external transfer of all those on the Child Protection Plan / Child In Need Plan records
should be sent with two copies of this form to the designated nurse.
For all internal transfers a single copy of this form should be sent to the designated nurse.




Version 3.   Page 67 of 80    Child Protection policy and procedure Sep 2008                 67
Appendix 8

       Brent
                                                           Primary Care Trust


CONFIDENTIAL

REPORT FOR INTERAGENCY
(Case Conference Initial/Review/ Strategy Meeting/ Legal Planning Meeting/ Network/Professional
Meeting)


DATE OF MEETING

FAMILY NAME(S):                                   ETHNICITY:

ADDRESS



Name –             Relations    S    D.O.B.        HV/SN       Nursery / Address ( if other
Surname               hip       e    Age                       School    than above)
                                x
/&
Forename
(include
parent /
carers)




SOCIAL WORKER’S NAME,

SOCIAL WORKER’S BASE & TELEPHONE NUMBER:



Version 2   Page 68 of 81       DRAFT Child Protection policy and procedure Sept 2008       68
NAME & BASE OF PRACTITIONER COMPLETING REPORT:

OTHER PROFESSIONALS INVOLVED AND WITH WHOM:


                            Brent
                                                               Primary Care Trust

FAMILY NAME:                                         CHILD’S NAME……………………………




CONTACTS/DATES


CHILD’S DEVELOPMENTAL NEEDS



PARENTING/CARER’S CAPACITY



FAMILY & ENVIRONMENTAL FACTORS


SUMMARY

Signature)………………………………………Designation……………

Print Name……………………………………..Date…………………=

Copy of report to safeguarding children advisor, Brent tPCT


Version 2   Page 69 of 81           DRAFT Child Protection policy and procedure Sept 2008   69
Appendix 9        Legal Guidance for NHS Brent Employees (universal services)

                CIVIL                                                                    CRIMINAL
               COURT                                                                      COURT

 Staff member is contacted                                                 Staff member contacted by
 by the local authority or the                                             Police to appear in court to give
 court to give evidence in civil                                           evidence in criminal
 proceedings                                                               proceedings




 Designated/named nurse and line                                           Designated/named nurse and line
 managers are to be informed                                               managers are to be informed
 immediately                                                               immediately




 Prior to the Court Case, the designated                                   Prior to the court case, the Designated
 or named Nurse will discuss the                                           or Named Nurse will discuss the
 statement and giving evidence in Court                                    statement and giving evidence in Court
 with the Practitioner. Records will be                                    with the Practitioner. Records will be
 reviewed with the Practitioner to ensure                                  reviewed with the Practitioner to ensure
 easy retrieval of information pertinent to                                easy retrieval of information pertinent to
 the statement.                                                            the statement.




 The health professional will refer to his                                 Staff member will be appearing in
 /her report or statement. Professional                                    criminal court giving evidence on the
 records must be also taken to the court.                                  statement they gave to the police.
 If referred to during giving evidence the                                 Following discussion with the
 court may request access to the notes,                                    Designated Nurse
 this cannot be refused.                                                   legal advice may be sought from NHS
                                                                           Brent legal advisers.




 Manager, Designated Nurse or Named                                        Manager, Designated Nurse or Named
 Nurse attend court with staff member.                                     Nurse attend court with staff member
                                                                           who may also invite his or her own
 These courts are closed to the                                            support person.
 public
                                                                           These courts are open to the
                                                                           public




Version 2    Page 70 of 81               DRAFT Child Protection policy and procedure Sept 2008                 70
Appendix 10                    Safeguarding Children Supervision NHS Brent



     Responsibilities of Supervisee                      Responsibilities of Supervisor
Organise appropriate venue for supervision if       Provide additional support to newly qualified
this is not to take place in the supervisors        /appointed practitioners in line with agreed
office                                              protocols
Identify children/families for supervision who      Ensure practitioner is aware of the
are subject to a child protection plan, looked      expectations, responsibilities and boundaries of
after or identified as vulnerable                   child protection supervision.
Prepare in advance for the session with             Establish a safe environment for supervisee to
information about the family profile, details of    explore practice issues
assessments and current involvement.
Manage time effectively so that supervision is      Minimise interruptions during supervision and
prioritized and sessions are attended promptly.     ensure that sessions are kept to the agreed time.
Give adequate notice to supervisor of
cancellation or delay
Be open to exploring practice issues and            Give adequate notice to supervisee of
reflecting on experiences                           cancellation or delay.
Understand the importance of receiving              Provide objectivity and critical analysis
constructive feedback on cases and practice
issues
Be aware that the practitioner is professionally    Provide support and constructive feedback
accountable for their individual practice with
children and families.
Concerns about unsafe practice, which it has        Understand and engage with the strengths,
not been possible to address effectively in         differences, values and feelings of the
supervision, will be shared with the line           supervisee.
manager.
If plans agreed in supervision for                  Challenge poor practice and ensure there is
children/families are not achievable e.g. non-      communication with supervisee’s line manager
compliance of family, the practitioner should       if issues cannot be resolved in supervision
inform the supervisor.
If plans agreed in supervision are not actioned     Following the supervision session, ensure that
because of staffing resources the line manager      plans agreed for individual cases are
and the supervisor should be informed.              documented in the child/family record and
                                                    signed by the supervisor and supervisee.
Prepare reports in advance for Child Protection     Document clearly in the supervision notes
Conference sharing the content with the             other general practice issues discussed in
supervisor                                          relation to safeguarding children.
Agree jointly with the supervisor when a            Reinforce with supervisee, the need for further
child/family no longer fits the criteria for        discussion if plans are not achievable
discussion.
Consult with supervisor in between planned          Liaise with Line Manager if there are resource
supervision sessions if there is an escalation in   issues, which are impacting on the provision of

Version 2   Page 71 of 81         DRAFT Child Protection policy and procedure Sept 2008            71
concern about a known or new case                    a safe service for children and families.
Seek advice other members of the safeguarding        Review Child Protection reports and attend
children team, if your supervisor is not             Child Protection conferences or other meetings
available to provide support on a case where         with supervisee if the need for additional
this is required immediately                         support is identified.
Awareness of relevant policy and procedures          Where possible provide “ad hoc” advice on
                                                     child protection issues to supervisee or ensure
                                                     that they are clear where to access advice.
                                                     Ensure that this is documented
Discuss learning and developmental need in           Reinforce the requirement to adhere to relevant
relation to safeguarding                             policies and procedures.
Access relevant training in line with PCT            Support the supervisee in identifying learning
Mandatory training requirements.                     and developmental needs. If training needs are
                                                     not met by courses provided/available in the
                                                     PCT or by Brent LSCB, discuss with the
                                                     Designated Nurse Child Protection who will
                                                     discuss further with the Learning and
                                                     Development Team.
Any difficulties in the supervisory relationship     Any difficulties in the supervisory relationship
should be raised in the first instance with the      should be raised with the relevant manager
supervisor, If this is not possible this should be   after discussion with the supervisee.
discussed with the supervisee’s manager and
your line manager
Other requirements please state                      Other requirements please state




Dates agreed for         1st Quarter         2nd Quarter          3 Quarter rd         4th Quarter
  12 months

     Venue
Practitioner                               Supervisor
Signature                                  Signature
Date                                       Date




Version 2   Page 72 of 81          DRAFT Child Protection policy and procedure Sept 2008             72
     Brent
Appendix 11
                             Teaching Primary Care Trust
     Safeguarding Children/Vulnerable Families/Child Protection Supervision Record
DATE & TIME
Staff Informant
Contact Details
FAMILY Name/s
Family/MPI/NHS
number
ADDRESS



Clinic/Nursery/
School attended
Social Worker &
Contact Details

CHILDREN
                                   Surname        Forename




                                 DOB Category of Risk Child
                                    Protection Plan /
                                          CIN/
  LAC                   Date on/off CPP/CIN         Legal Status




 Brief account of information using the Assessment Framework ( DOH 2000)




 Signature & Date of supervisor
 Signature & Date of supervisee


Version 2   Page 73 of 81      DRAFT Child Protection policy and procedure Sept 2008   73
Version 2   Page 74 of 81   DRAFT Child Protection policy and procedure Sept 2008   74
       Family                                                                      BRENT


Supervisor                                                       TEACHING PRIMARY
CARE TRUST
Practitioner

Advice/Discussion




Action agreed/Care Plan




Outcomes/timescales expected




Date of review

Practitioner                                        Supervisor
Signature:
Printed Signature
Designation
Date

Cc:     Clinical records       Child Protection/Special Need File               Supervision
File    


Version 2   Page 75 of 81       DRAFT Child Protection policy and procedure Sept 2008       75
                                  NHS Brent NHS Trust - Safeguarding Children Arrangements - 2008

Appendix 12
                                                                              NHS Brent
                                                                               Board


                          Medical Director                   Director of Public           Director of Provider                  Clinical
                                                              Health lead for             and Estates Services              Governance Lead
                                                               Safeguarding                                                    for PCT
                                                                 Children

                          Designated Doctor
                           Child Protection

                                                                                           Designated Nurse                    Safeguarding
                                                                                                                                 Children
                                                                                                                               Administrator
                Named Doctor              Named GP with
               Child Protection           Special Interest




                              Child Death               Child Protection          Named Nurse            Child Protection    Paediatric Liaison
                              Coordinator                   Advisor               Safeguarding               Advisor              Nurse
                                                                                    Children



   Brent
  L.S.C.B
 Coordinator




Version 3 Page 76 of 81           DRAFT Child Protection policy and procedure Sept 2008
Appendix 13 - Assurance Form
Safeguarding Children Policy and Procedures

Department: …………………………...

I have read and understood the above document and agree to abide by its content.

              Name                   Signature                      Date




Version 3 Page 77 of 81   DRAFT Child Protection policy and procedure Sept 2008
Appendix 14

                               Child Protection Policy and Procedures – 2008
                                     Equality Impact Assessment Tool
                                                      Yes/No             Comments
 1.   Does the policy/guidance affect one
      group less or more favourably than
      another on the basis of:
         Race                                           No
         Ethnic origins (including gypsies and          No
          travellers)
         Nationality                                    No
         Gender                                         No
         Culture                                       Yes      There is a need to take
                                                                 into account cultural
                                                                 issues when assessing
                                                                 some situations where
                                                                 they have an adverse
                                                                 impact on the health or
                                                                 well being of Children
                                                                 and Young People
                                                                 (C&YP) including unborn
                                                                 babies
         Religion or belief                            Yes      There is a need to take
                                                                 into account religion or
                                                                 beliefs when assessing
                                                                 some situations where
                                                                 they have an adverse
                                                                 impact on the health or
                                                                 well being of (C&YP)
                                                                 including unborn babies
         Sexual orientation including lesbian,          No
          gay and bisexual people
         Age                                           Yes      Statutory requirement to
                                                                 promote and safeguard,
                                                                 (C&YP) including unborn
                                                                 babies
 2.   Is there any evidence that some                    No
      groups are affected differently?
 3.   If you have identified potential                  Yes

Version 3 Page 78 of 81         DRAFT Child Protection policy and procedure Sept 2008
                                                   Yes/No             Comments
      discrimination, are any exceptions
      valid, legal and/or justifiable?
 4.   Is the impact of the policy/guidance            No
      likely to be negative?
 5.   If so can the impact be avoided?                 -
 6.   What alternatives are there to                None      Legal requirement to
      achieving the policy/guidance                           safeguard all C&YP
      without the impact?                                     including unborn babies
                                                              to protect their Human
                                                              Rights.
 7.   Can we reduce the impact by taking              No
      different action?

If you have identified a potential discriminatory impact of this procedural document, please refer it to
the Equality & Diversity Manager together with any suggestions as to the action required to
avoid/reduce this impact.
For advice in respect of answering the above questions, please contact the Equality & Diversity
Manager.




Version 3 Page 79 of 81      DRAFT Child Protection policy and procedure Sept 2008
Appendix 15 - Reference

National Policy, Legislation and Guidance

       These procedures complement and are to be used alongside:
           What to do if you are worried a child is being abused DfES (2006): Every Child Matters
             – Change for Children (2006) DfES
           Information Sharing: Practitioners ‘ guide. DfES London (2006)
           London Child Protection Procedures London Safeguarding Children Board (3rd Edition
             2007)
           'Working Together to Safeguard Children' DfES, HM Gov (2006) (WT 2006)
             www.ecm.gov.uk/workingtogether
           'The Framework for Assessment for Children in Need and their Families' DoH, Home
             Office, D of E, (2000)
           The National Service Framework for Children, Young People and Maternity Services
             (NSF) 2004 – Standard 5

Relevant guidance and legislation
          Children Act, 1989 and 2004 (Chapter 12),
          Human Rights Act, 1998,
          Data Protection Act, 1998.
          The Caldicott Standards




Version 3 Page 80 of 81    DRAFT Child Protection policy and procedure Sept 2008
                               Draft Policy

                                      ↓
                          Policy agreed at PEC

                                         ↓
                          Policy ratified at Board

                                     ↓
                    Policy uploaded to the intranet

                                     ↓
                        Publicity of Policy
    Send to Communications Department for Communication
    Bulletin and team brief / Policy discussed at meetings e.g.
                   Senior Directorate Meetings

                                        ↓


     Present at staff forums / meetings e.g. Senior Directorate
                              Meetings

                                        ↓
       Present at staff forums / meetings e.g. Senior
                   Directorate Meetings




Version 3 Page 81 of 81         DRAFT Child Protection policy and procedure Sept 2008

								
To top