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A Conference on Joint Working in Hampshire


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Title: A Conference on Joint Working in Hampshire


  • A Conference on Joint Working in Hampshire

  • Housekeeping
  • Alarms
  • Toilets
  • Smoking
  • Breaks
  • Register

  • Learning Outcomes
  • Promote the use of the three revised 4LSCB
  • Raise understanding of how to use the protocols
  • Explore challenges to implementation
  • Consider changes in practice


Agenda 0945 - Keynote address 1000
Introduction to the protocols 1045 -
Tea/coffee 1115 - Case study exercise 1230 -
Plenary session 1300 Close
  • Next Steps
  • Raise awareness within your organisation.
  • Promote and ensure use in practice and
  • Auditing of use and compliance.

  • END
  • Presentations will be sent out.
  • Please complete the survey monkey evaluation.
  • Have a safe journey home!

HSCB Conference Joint Working in Hampshire
  • Andrea OConnell
  • Director of Quality West Hampshire Clinical
    Commissioning Group

(No Transcript)
Aim of today
  • Promote the launch of the 3 multi- agency
  • Raise your understanding of the key changes
    within the documents
  • Give you an opportunity to use the protocols
  • Consider changes in practice
  • Explore some of the challenges to their

Everyone who comes into contact with children
and families has a role to play(Working Together
  • The protocols have been developed and revised as
    a direct result of learning from recent local
    serious case and multi agency reviews
  • Application in practice will
  • protect children
  • support Practitioners in the early identification
    of abuse and neglect
  • Support the early help agenda

Expectations of you
  • Consider how you will cascade the protocols
    within your organisation
  • Ensure that key changes are understood amongst
    your staff
  • Ensure that the protocols are consistently
    applied to practice
  • Monitor the use of the protocols

  • These protocols are not new, they have been in
    place for sometime, however their use has not
    always been applied to practice
  • This has made children more vulnerable
  • In future we need to ensure the protocols are
    understood and used- across agencies to
    effectively safeguard and protect children

Joint Working Protocol Update February 2014
  • Sheila Hodgkinson and Helen Hudson
  • Safeguarding Children Team
  • Hampshire Hospitals Foundation Trust

  • A protocol to provide a robust framework for
    responding to safeguarding concerns for unborn
    babies and neonates within Hampshire and the Isle
    of Wight
  • To enable practitioners to work together with
    families to safeguard unborn babies where risk is
    identified (section4-risks)
  • The antenatal period gives a unique window of
    opportunity for practitioners and families to
    work together
  • Applies to any practitioner working within health
    and childrens services
  • Make plans

What's New?
  • More emphasis on using Early Support
  • If CAF or TAC (Early Support Hub) is used and
    there is a high level of concern consider
    inviting CSD to the meeting
  • Review regularly (and document) reasons for not
    making a referral or completing an assessment to
    consider risks and if any further action needed.

What's New?
  • Remember CAF/Early Support is not required where
    it is identified that the UBB has already met the
    threshold of being at risk of significant harm
  • The optimum time for ICPC is between 28-32 weeks

  • Safeguarding birth plan to be developed by 34
    week including any agreed decision for a home
    birth (see checklist)
  • CSD are to ensure that Out of Hours are made
    aware of safety planning

  • It is recognised that hospitals are not secure
    settings or a place of safety so supervision may
    need to be put in place by CSD
  • If extended hospital stays are required for
    social reasons only this needs to be risk
    assessed individually and hospitals may charge
    the LA in these situations
  • Police protection units must be informed of the
    safeguarding birth plan if Police Protection is
    going to be considered.

On going challenges
- Impact on baby attachments Mental capacity
issues during labour and agreeing section
20 -Partners who are RSOs -Perinatal mental
health service for 16-17 year olds - Impact on
other families in maternity
In conclusion main changes
  • Consider Early Help
  • Information sharing
  • Planning in pregnancy weeks, no one told the baby
    their due date.
  • Any questions

Safeguarding children whose parents/carers have
problems with mental health, substance misuse,
learning disability and emotional/psychological
  • First written in 1999
  • Hampshire, IOW, Portsmouth Southampton
  • Purpose
  • Early help before safeguarding becomes an issue
  • Multi-agency
  • Still not widely known and used
  • Need organisations and staff to own it

Safeguarding children whose parents/carers have
problems with mental health, substance misuse,
learning disability and emotional/psychological
  • Key messages
  • Separate key messages flowchart
  • Awareness of children and adults in the household
  • Information can and should be shared
  • Eligibility criteria does not trump safeguarding
  • Risk increases when more than one problem exists
  • Be persistent

Safeguarding children whose parents/carers have
problems with mental health, substance misuse,
learning disability and emotional/psychological
  • Key messages
  • People want help to parent their children well
  • Dont let anyone be invisible
  • Work with strengths
  • Follow your instincts and seek support/advice
  • Family centred approach
  • Work together

4LSCB bruising protocol 2013 revision
  • Jean Price
  • February 2014

Case example
  • A young child a few months of age presented to a
  • Child was unwell (miserable, Grizzly, off food)
  • Doctor noticed she had small bruises to her face.

Case example
  • Doctor treated her for slight infection, and
    agreed to follow up 3 days later.
  • Child was on life support and died

Case example background
  • Mother had a difficult pregnancy and Birth
  • Mother felt the child was difficult to feed and
    care for and mother was depressed
  • Child not bonding to either parent

Case example
  • Post Mortem -
  • subdural haemorrhage
  • facial and body bruising
  • 3 fractured ribs

Case example - SCR
  • Independent author of SCR criticised the Bruising
    protocol stating it was not clear who to refer
    to when a premobile child presented with bruising
  • Recommended Revision of protocol
  • Training

Bruising protocol
  • First developed 2010
  • Concerns re professionals not appreciating the
    possible seriousness of bruises(small) infants
  • Reflected in National SCRs

Shaken babies
  • Serious
  • Loss of consciousness
  • Coma
  • Collapse
  • Apnoea (breathing difficulties)
  • Fits
  • Mild
  • Poor feeding
  • Irritability
  • Lethargy
  • Vomiting
  • Isolated fit

Current position
  • 4LSCB bruising protocol introduced 2010
  • Revision planned Jan 2011- delayed pending audit
    of current practice
  • Recent Hants SCR recommendation to have new
    protocol in place by 31st Jan 2014

Combined audit data Solent EW
  • 29 infants seen
  • 8 birthmarks
  • 5 accidental injury
  • 2 other (1 no injury, 1 unexplained)
  • 14 investigated, fractures found in 3
  • Care proceedings in 7

Audit findings Solent W 2012/13 (1)
  • 17 referrals of non-mobile lt1s accepted for
    examination, 16 seen by Solent W paed and 1 by
  • 5 birthmarks (of which 2 were fully investigated
    before diagnosis clear)
  • 3 accidental explanations accepted
  • 8 Likely inflicted injuries (7 bruising, 1 burn)
    - full investigations
  • 1 unexplained, clotting studies only (UHS case)

Audit findings Solent W 2012/13 (2)
  • 8 infants investigated fully fractures found in
    2 (1 of whom had been seen previously with torn
    frenum and ear bruising)
  • - 2 cases closed after s47 enquiries, no case
  • - 1 case conference and child protection plan
    (mother admitted causing injury)
  • - 5 removed, care proceedings in progress

Why have a bruising protocol? 1
  • 13/43 children admitted to a regional centre
    because of serious abusive injuries had a
    harbinger injury
  • 11/13 harbinger injuries were bruises
  • 8/13 harbinger injuries had been seen by a health
  • Only 1 child had been referred to childrens
    services at the time of the initial injury
  • (Coupes and Smith 2006)

Revised protocol (1)
  • Remains a protocol
  • Applies to non-mobile infants up to age 2yr
  • Applies to all those whose work brings them into
    contact with children

Revised Protocol (2)
  • A seriously ill or injured infant should be
    referred to hospital immediately
  • Inform Social Care

Revised protocol (3)
  • If anyone notes a bruise
  • Record what is seen and any explanation offered
    (body diagram if possible)
  • Inform parents/carers that you are obliged to
    follow the bruising protocol
  • Refer to childrens social care (MASH) who will
    take responsibility for further assessment
    including arrangements for a paediatric opinion
    within 24hr (ideally same day)

Revised protocol (4)
  • Specific considerations
  • Birth injury- follow protocol if in doubt about
    origin or features
  • Birthmarks- may not be present at birth. If
    unsure whether the mark is a bruise, discuss with
    primary care team in the first instance
  • Injury explained as self-inflicted or caused by a
    sibling- refer

(No Transcript)
Thank you
  • Jean Price
  • Designated Doctor
  • Southwest Hants CCG
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