Proactive in protection in Implementation of Visible, Accessible and Integrated Care

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Proactive in protectionin Implementation of
Visible, Accessible and Integrated Care

• Lindsay Ferguson
• Lead Consultant Nurse
  Child Protection for Scotland

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Lead Consultant Nurse SEHD

• Scoping structures across health boards
• Representing NMAHP at national policy strategic
  levels in CP DA
• Establish links between professional
  organisations, academia, policy development
  practice
• Work with all SE departments on cross cutting
  issues to ensure policies developed relate to CP
• Commission studies development work on CP
  LAAC health needs
• Development of National Interagency Training
  Strategy
• Advising CNO Ministers on relevant issues
  arising

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The Zeitgeist
Shift from reaction to pro-action Its everyones
job to make sure Im alright To Getting it right
for every child
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Its everyones job to make sure Im alright
2002
Report of National Child Protection Audit
Review found that children experience very
serious levels of hurt and harm and live in
conditions and under threats that are not
tolerable in a civilised society.
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Its everyones job to make sure Im alright
2002

• 3 yr Child Protection for Reform Programme
• Childrens Charter
• Framework Standards
• Guidance for CPCs
• Multi-agency inspection
• National interagency training strategy
• 24hr ChildProtectionLine 0800 022 3222
• Evaluation positive

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The vision Getting it right for every child

• Successful learners
• Confident individuals
• Effective contributors
• Responsible citizens
• They need to be
• safe, healthy, achieving, nurtured, active,
  respected, responsible and included.

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An Action Framework for Children and Young
Peoples Health in Scotland (2007)

• Ensure parents/carers are supported mentored -
  pre conception until the child is in early
  adulthood.
• Improve accessibility to a range of health
  services for young people through active
  ongoing engagement with them.

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Children and Young Peoples Mental Health A
Framework for Promotion, Prevention and Care

• Parents in difficult circumstances need support
  and help
• Interventions which improve and enhance wellbeing
  of mother and baby to promote attachment
• Promote role of fathers

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Infant Mental Health
A guide for Practitioners (2007)

• First year - synaptogenesis and pruning
• Neural pathways strengthen if used, decay if not
  used
• Babies need a warm, sensitive, responsible adult
• Opportunistic early intervention

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Social Work Research

• New approach to risk assessment management as
  current systems
• Are reactive, adversarial stifle professional
  autonomy
• Preoccupied with thresholds
• Bring about short-term crisis intervention
• New approach should
• See risk as positive as well as potentially
  harmful
• Allow worker discretion
• Ensure harm is reduced
• Adopt a participative, holistic, proactive
  approach
• Open governance
• Needs a confident workforce, sound leadership a
  culture open to learning from mistakes

M.Barry - unpublished
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HMIE Inspections issues for health

• Health not involved in process consistently
• Information sharing not reliable
• Staffing issues in some areas
• Risk assessment, care planning and decision
  making generally poor
• Record keeping and use of chronologies needs
  improvement
• Longer term sustained interventions required
• Roles need clarification

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Facing the future A review of the role of
health visitors

• HVs have high credibility with families
• Need to reform in modernising services
• Part of fully integrated preventative service for
  children and young people to
• Improve health and wellbeing
• Address the key public health issues
• Deliver measurable outcomes for individuals and
  communities
• Deliver Government policy
• Competent teams led by HVs

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Aspiration
Each child should realise his/her potential in
terms of emotional and social maturity, be in
good health and have attained a level of academic
achievement and other skills. For Scotlands
Children (2001)
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Current messages re. priorities from ministers

• Early years strategy
• Parenting
• Early intervention? Primary or secondary
  prevention
• Health of school age children
• Health of looked after children
• Getting it right for every child
• Review of nursing in the community
• Better Health Better Care-best possible start

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Foster a change from reaction - - -

• Intervention too late
• Emphasis on deficits
• Damage limitation
• Working with abuse not protection
• Arbitrary thresholds for services
• A few very skilled nurses

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- - - to pro-action

• Primary, secondary and tertiary prevention
• Actively seek out vulnerability
• Assess needs not just risk
• Anticipate needs
• Intervene early
• Individualised single multi-agency care plans
• Identify utilise strengths in family
  community
• Skilled workforce for children and families

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Visible, Accessible Integrated Care The
issues raised in relation to child protection

• Children not included
• Who will assess family health needs
• Vulnerable families will be missed
• HVs feel they dont have time to do both public
  health and family intervention
• The role of the HV disappearing
• Concern about the generic role of CHN
• Education not appropriate for role

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Some suggestions

• The review looked at nursing needs of communities
  rather than specific groups or individuals
• Assessment of family health needs can be done by
  team of practitioners midwife, GP, CHN, staff
  nurses
• Care plans agreed with families and appropriate
  person with the right skills deployed
• Integrated assessment in complex cases where
  another agencys involvement required

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More suggestions

• Whole work force will work to principles of HV
  led by experienced public health nurses (CHN)
• CHN will be supported by multi-skilled team,
  advanced practitioners and consultant nurses as
  well as other agencies, families and communities
• Education programmes being reviewed in line with
  Modernising Nursing Careers

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Benefits for children and families

• Whole work force involved in promotion of health
  and wellbeing
• One identified contact person
• Vulnerable children families identified sooner
• The right person with the right skills deployed
  to intervene as early as possible
• Roles clarified
• Strengths and resources in communities and
  families utilised in a public health context
• Better interagency working
• Greater involvement of children young people in
  planning
• Gaps in skills and services identified

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We are not alone

• Strong drive and will to improve working together
• Greater public involvement
• Integrated service structures
• Respect for strengths and resources in families
• Respect for the skills of practitioners in other
  agencies
• Community development initiatives to utilise
  resources in communities
• Supportive National Policy

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The big picture - A public health issue?

• Its everyones job to protect children
• Responsibility of parents/carers extended
  families
• Responsibility of government communities
• Address issues of poverty
• Safe healthy environment
• Good housing
• Promotion of wellbeing
• Violence reduction
• Primary prevention

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Barlow (2006) recognises the need to shift from
child protection to family support and improved
parenting and that it should be focused on needs
at individual, family and community levels.
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The public health approach

• Lazenbatt and Freeman (2006) suggest that the
  statistics
• regarding child physical abuse in the UK justify
  it being
• regarded as a public health issue across
  socio-economic
• groups
• 7 of children in UK have been reported as
  suffering serious physical abuse by a parent or
  carer (NSPCC 2000),
• 2 children under 15 years die from abuse or
  neglect each week in UK (DoH 2003, Creighton
  2004).
• 10,527 referrals to child protection services in
  Scotland 2005-6
• 45 on CPR for physical neglect

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The literature

• No one group of practitioners take the
  responsibility for enabling the most vulnerable
  children and families to engage with universal
  services. Growing Progress 2003
• Move away from deficit model of supporting
  families building on strengths theory of
  salutogenesis. Taylor 2000
• See family violence as a public health problem.
  Landenburger, Campbell and Rodriguex 2004
• Some health professionals frightened to identify
  child abuse due to lack of training and
  experience. Hall 2003, Nayda 2004, Jackson 2005

)
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Literature contd

• Public health nurses carry most of the
  responsibility for CP. Crisp and Lister 2004
• HVs taking on roles of SW due to lack of
  resources. Appleton J1996
• Primary prevention helps families to care for
  children at home. Pecora et al 2006
• Links with adult services need strengthening.
  Statham 2004
• Need to look to the community to work with
  agencies to reduce child abuse and neglect.
  Pecora et al 2006, Laming 2003, Nelson and
  Baldwin 2004

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Public health approach

• public health approaches will be considered to
  be an integral component of a truly comprehensive
  child protection service.
• Roles of other disciplines are being developed in
  Scotland
• Crisp and Lister (2004)

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Todays challenges

• Cyclical abuse
• Substance misuse
• Domestic violence abuse
• Neglect
• Impact of parental mental ill-health
• Impact of parental learning physical disability
• Societal stressors poverty, unemployment
• Sexualisation of children
• Over protection of children

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Identify the most vulnerable

• Children young people whose parents/carers
  cannot provide for all their needs
• Children looked after by the local authority
• Young carers
• Asylum seekers
• Trafficked children
• Adults (who may be parents or carers) in need of
  support protection

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Build capacity capability of workforce for
children families

• Build on existing skills structures
• Child protection nurses, consultants advisers
• Consultant nurses, midwives AHPs
• Advanced practitioners
• Specialist childrens workforce
• Looked After Accommodated Childrens Nurses
• Paediatric forensic nurse examiners

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.and more

• Capitalise on all practitioners roles to protect
  children through their work with families
  communities
• Public health practitioners
• Allied health professionals
• Mental health professionals
• Paramedics
• Emergency care
• Dentists
• GPs etc.

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Enhance universal services

• Build capacity capability to improve well being
  of communities, families individuals
• Non stigmatising services for all
• Anticipatory action
• Primary prevention
• Early intervention
• Access for excluded population
• Signposting to other services

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Enabling model of working

• Provide support training, supervision strong
  management
• Robust lines of accountability interagency
  structures
• Emancipation of workforce permission to use
  professional integrity to act in best interest of
  children
• Empowering parents carers to do the best they
  can for their children

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Enabling model for Health Boards for working
with children families
Children, young people and families
Training Front line practitioners,
assistants support workers
Individual Primary prevention early
intervention Supervision
Advanced practitioners for
CF CPC sub-groups
Secondary prevention

Operational Management Consultant
nurse for CF
CPC Tertiary
prevention Senior management
team Executive lead
Health Board

for CF Support
Accountability
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A service for all children and families

• Share care not refer
• Work together
• Utilise all the workforce resources
• Advocate for needs of children families
• Define health practitioners roles
• Assessments of need (risk) care plans with
  measurable outcomes
• Evidence based practice
• Public health roles

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It is everyones job but advice guidance is
available

• Executive leads for child protection
• Clinical leads for child protection
• Child protection nurses
• Health Action Groups
• CPCs

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The outcomes

• All who work with children, young people
  families act to support or protect them as soon
  as possible
• Organisations support all practitioners to act as
  soon as possible
• Families supported to keep their children safe
  learn to manage risk
• Number of children needing protection will reduce
• The quality of life improved
• Children have a better chance of fulfilling their
  potential
• The protection of children is everyones job

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Primary prevention-children families (including
older people adults)

• Antenatal screening and anticipatory action
• Domestic abuse
• Mental illness
• Substance misuse
• Family health assessment
• Health screening and surveillance
• Early intervention
• Parenting

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The Culture

• Honour childrens human rights
• Role model non-judgemental, non-victim blaming
  approach regardless of lifestyle choices
• Sensitivity to issues of diversity culture
• Promote trust, honesty openness
• Encourage true partnership
• Value professional judgement
• Respect for the skills expertise of others

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The future

• Each individual is unique
• Respond to the needs not the diagnosis (or
  category on the child protection register)
• Primary prevention approach
• Customised parenting support for all families
• Comprehensive multi-agency assessment of needs
  when required
• Accessible, equable, integrated services
• The right person doing the right thing at the
  right time
• Anticipatory action when possible

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1. Share care

• To refer means to share not hand over
• Everyone using their specific skills
• Be clear about each practitioners and parents
  role in care plans
• Work towards planned agreed measurable realistic
  outcomes for children

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2. Work together

• With communities, children, young people their
  families
• With practitioners from all agencies by
• Challenging barriers between organisations
• Working towards integration
• Clarifying roles
• Sharing a common language
• Breaking down professional protectionism

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3. Utilise whole workforce

• Greater awareness of issues
• Ethical practice non judgemental, non victim
  blaming
• Enable facilitate practitioners to take action
• Encourage anticipation
• Early intervention
• Support supervision
• Good management of resources

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4. Advocate for the needs of children

• Assert childrens rights
• Listen to children
• Speak their language
• Identify gaps in services

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5. Define health practitioners roles

• Describe what is expected
• Declare boundaries of responsibility
• Clarify competencies, knowledge skills needed
• Maintain health focus
• Better understanding of the skills of other
  practitioners
• Interagency training development

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6. Assessments care plans with measurable
outcomes

• Named practitioner
• Family health assessments
• Core, additional or intensive care needs
• Use practitioners with the right skills set to
  meet needs
• Contribute to integrated assessments
• Clear health goals identified
• Contingency plans

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7. Evidence based practice

• Lead on research to build body of knowledge
• Identify efficacy of roles
• Lead on audit evaluation
• Learn from reviews inspection reports
• Disseminate findings
• Encourage innovation

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8. Public health

• Survey community health needs
• Community development
• Public participation in service planning
• Health education promotion
• Health screening surveillance
• Immunisation
• Public safety inclusion agenda
• Parenting