Safeguarding Children Practice Guidance Note V02 Planned

Cumbria Northumberland, Tyne and Wear NHS Foundation Trust SC-PGN-03 – Addiction Services – Pregnancy Pathway Guidance – V02- -Issue2- Oct 19 Part of CNTW(C)04 – Safeguarding Children Policy

Safeguarding Children Practice Guidance Note

Addiction Services - Pregnancy Pathway and Guidance – V02

Date Issued Planned Review PGN No:

Issue 1 –Dec 2018

Issue 2 – Oct 19

Dec 2021 SC-PGN-03 Part of

CNTW(C)04 - Safeguarding Children

Author/Designation Margaret Orange – Treatment Effective Nurse and Governance

Manager (Addictions)

Responsible Officer

/ Designation Eilish Gilvarry – Consultant Psychiatrist Anne Moore – Group Nurse Director, Safer Care

Contents

Section Description Page No

1 Introduction 1

2 References 1

3 Common Principles 3

4 CNTW Responsibilities in relation to Substance Misuse and Pregnancy

4

5 Antenatal Period 4

6 Admission Period 5

7 CNTW roles in relation to Substance Misuse and Pregnancy 7

8 Services not in Current Treatment 9

9 Non-attendance Process 9

10 Management of Prescriptions 9

11 Electronic Patient record recording by Keyworker 10

12 Pregnancy Review Meetings 10

13 Audit 11

14 Safeguarding 11

Appendices – attached to PGN

Appendix No: Description

Appendix 1 Pathway

Appendix 2 Protocol - Early Help Assessment (EHA)/Common Assessment Framework (CAF)

Appendices – listed separate to policy

Appendix No: Description

Appendix 3 Pregnancy Register

Cumbria Northumberland, Tyne and Wear NHS Foundation Trust 1 SC-PGN-03 – Addiction Services – Pregnancy Pathway Guidance – V02-Dec 18 Part of CNTW(C)04 – Safeguarding Children Policy

1 Introduction 1.1 In general terms, approximately 30% of people seeking help for substance misuse

problems are female and approximately 90% females in substance misuse treatment are of reproductive age. Substances, especially opiates, can lead to reduced fertility alongside irregular or absent periods. This may lead to lapses in the use of contraception.

1.2 This guideline has been produced to clarify the role of Cumbria Northumberland,

Tyne and Wear NHS Foundation Trust (the Trust/CNTW) Substance Misuse Services in working with women who are pregnant whilst receiving a substance misuse service.

1.3 The guideline and pathway was produced to support a standard approach following

learning from significant event analysis. 1.4 As a principle, it acknowledges that substance misuse may impact upon an

individual’s ability to sustain a healthy pregnancy and subsequently care for a child, and that interventions to assess risk and safeguard the health and wellbeing of the child and parent are paramount.

1.5 Substance misuse in pregnancy may adversely affect the foetus and lead to a

range of problems including premature birth and/or low birth weight. A new born may also develop withdrawal symptoms and require treatment.

2 References 2.1 There are several national and internal texts which provide the evidence base in

relation to pregnancy and substance misuse and which were considered in developing this process. They should also be the guidelines referred to for support when managing pregnant substance users.

2.2 Guidelines for the Identification and Management of Substance Use and

Substance Use Disorders in Pregnancy (WHO 2014) have been developed to enable professionals to assist women who are pregnant, or have recently had a child, and who use alcohol or drugs or who have a substance use disorder, to achieve healthy outcomes for themselves and their foetus or infant. After a broad review of the needs of this population and challenges faced by health-care providers working with pregnant women with substance use disorders, these guidelines were developed to focus on six areas:

Screening and brief intervention

Psychosocial interventions

Detoxification

Dependence management

Infant feeding

Management of infant withdrawal

The guidelines also go on to rate the strength of the evidence in order to support clinical practice in all of these areas.

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Cumbria Northumberland, Tyne and Wear NHS Foundation Trust 2 SC-PGN-03 – Addiction Services – Pregnancy Pathway Guidance – V02-Issue2- Oct 19 Part of CNTW(C)04 – Safeguarding Children Policy

2.3 Problem parental drug and alcohol use: a toolkit for local authorities (PHE 2018) was developed for commissioners of alcohol and drug services to support understanding of the extent of problem parental alcohol and drug use in their area and how this can impact on children aged between 0 and 18 in the same household. This can also be of use to local providers in understanding context and extent of problems in local areas.

2.4 Drug misuse and dependence; UK guidelines on clinical management (DoH

2017) is often referred to as the Orange Book and is clear, evidence based guidance for clinicians treating people with drug problems.

This 2017 version offers new guidelines on:

prison-based treatment

new psychoactive substances and club drugs

mental health co-morbidity

misuse of prescribed and over-the-counter medicines

stopping smoking

preventing drug-related deaths, including naloxone provision This guidance also has a specific section on Pregnancy and Neonatal Care which highlights- Outcomes in opioid-dependent pregnant women are better, both in terms of the pregnancy and the outcomes for the neonate, for women who enter methadone treatment programmes during pregnancy and cease illicit drug use, than for those who do not. Women attending treatment services usually have better antenatal care and better general health than drug-using women not in treatment, even if they are still using illicit drugs. Therefore, services are advised to fast-track pregnant women into drug treatment to allow for the earliest engagement possible. Engagement of drug-misusing partners in treatment is also important in enabling pregnant women to achieve progress at the earliest possible stage. These guidelines also cover a range of special considerations including;

The treatment of pregnant women who misuse drugs in prison

Unknown pregnancy, miscarriage and termination

Management by a multidisciplinary team

Management of antenatal care

Maternal health problems

Effects of drugs on the foetus and baby

Substitute prescribing for pregnant women who use drugs

Prescribing opioids

Cocaine, other stimulants and cannabis

Benzodiazepines, Tobacco and Alcohol

Management of labour

Early neonatal care and withdrawals

Postnatal management These guidelines are the key reference for clinical delivery of substance misuse services to this group.

2.5 These guidelines also form the basis of the on-going training and supervision of

staff in CNTW Substance Misuse Services as well as informing the on-going risk assessment of the pregnant service user.

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3 Common Principles 3.1 This guidance is also based upon, and should demonstrate the CNTW components

of the common principles agreed for local Obstetric and Substance Misuse Pathway as outlined below (Common Principles- Appendix 1):

Common Principles

1. Professionals delivering care will have appropriate skills and knowledge to deal with substance misuse in pregnancy.

2. There must be a Multi-Disciplinary Team (MDT) approach to the management of high risk pregnancies involving

substance misuse.

3. Pregnant women with substance misuse problems must receive the same quality of care, respect and dignity as

presumed by any other woman.

4. There will be a clear understanding of professional roles and responsibilities to ensure quality of care throughout the

Pathway.

5. There will be a single plan of care agreed by the multi-disciplinary team.

6. The addiction service will undertake an assessment and following this will become the main prescriber throughout the pregnancy and following the birth with regard to substance

misuse related treatment

7. The addictions service will communicate with other agencies which drugs they intend to prescribe and which drugs will be prescribed by other agencies for example GP/ Obstetrician.

8. The safety of the child will be paramount.

9. There will be effective communication and integrated working between the following:

Addictions service,

NHCFT’s midwifery service including the maternity ante-natal substance misuse service.

GP.

GPWSI (GP with Special Interest).

Neonatologist where involved.

10. All agencies will have an understanding of Neonatal Abstinence Syndrome (NAS) and the risks in relation to the

administration and storage of Oromorph (morphine) medication.

11. A birth plan will ALWAYS be drawn up for child protection, child in need cases

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4 CNTW responsibilities in relation to Substance Misuse and Pregnancy 4.1 CNTW has introduced a Pregnancy Coordinator in each Addiction Service. It will

be their role to monitor the pregnancies in the service, including care and treatment, via a Pregnancy Register (Appendix 2) to ensure there is a clear understanding of the status of all pregnant women in each locality.

4.2 CNTW endeavours to ensure that the key goals of the Obstetric and Substance

Misuse Pathway Principles are met within the ante natal, admission and postnatal periods.

4.3 CNTW Addiction Services will review past mental health history and assess current

mental health need, liaising as appropriate with mental health services including IAPT and Perinatal CMHT to support an integrated care package.

5 Antenatal Period

5.1 Early identification of high risk pregnancy will be established through routine enquiry of a service user according to local guidance (Early Health Assessment (EHA)/ Common Assessment framework (CAF) Protocol Addiction Services – Appendix 2)

5.2 If there is any suggestion of pregnancy, an on the spot test will be offered via key

worker (or appropriate worker), followed by a laboratory test for confirmation, according to pregnancy testing local guidance.

5.3 The service users GP will be informed in relation to testing/results and, upon

confirmation of pregnancy, NTW Substance Misuse pregnancy coordinator in the locality, will be informed.

5.4 GP, Drug and Alcohol Midwife/Obstetrician and all other involved services will be

informed in relation to ensuring a multiagency, multi-disciplinary approach. 5.5 Risk assessment will be reviewed at confirmation of pregnancy to consider the

impact of the pregnancy. 5.6 A negative pregnancy result should also prompt a discussion around pregnancy

planning and contraception with the service user and action plan established to reduce future risk of unplanned pregnancy.

5.7 Consent will be sought to refer to EHA/CAF where pregnancy is confirmed or there

are any identified concerns/support requirements. 5.8 Safeguarding will be considered from the outset with decision making processes

and outcome clearly recorded in the electronic patient record. 5.9 The Trust’s CNTW(C)04 - Safeguarding Children Policy will be considered at all

times with the submission of an IR3 where concerns are identified.

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5.10 If abuse or neglect is known or suspected then a referral as per CNTW Safeguarding Children Policy will be submitted to LA Children’s Services. Consent is not required to refer.

5.11 The frequency the pregnant service user will be seen will be decided according to

clinical need, risk assessment and stability, with increased frequency where concern is escalated.

5.12 Frequency of contact with clear follow up arrangements and rational will be made

clear in the care plan. 5.13 Pregnant service users will be drug/breath tested at each appointment. 5.14 Keyworkers will follow the non-attendance guideline for any confirmed pregnancy

service user. 5.15 Service user will be monitored on the pregnancy register by the Addictions

Pregnancy Coordinator to ensure care is optimised and there is full MDT involvement.

5.16 Service user will be discussed throughout pregnancy at the Pregnancy Review

Meeting between Addictions and Midwifery staff where the birth plan will be share

6 Admission Period 6.1 Maternity Services will have been given clear contact details for key worker,

Pregnancy Coordinator and Consultant in Addiction Services at the confirmation of pregnancy and MDT planning.

6.2 Addiction Services will be invited to a pre-discharge meeting following delivery. 6.3 Discharge planning, including prescribing will be clearly outlined in written format

and shared with all partners as appropriate by CNTW staff. 6.4 Risk assessment will be reviewed throughout pregnancy as appropriate and post-

delivery, and shared as appropriate to minimise risk to parent and child.

Minimum Standards

On the spot pregnancy test followed by laboratory confirmation Risk assessment updated on confirmation of pregnancy including any safeguarding concerns Frequency of review and rational will always be made clear in the care plan Service user will be Urine/breathalyser tested at every appointment Service user will be reviewed at 12 week, 24 week and 36 week gestation as a minimum, involving medial Addictions staff

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6.5 If safeguarding procedures are initiated during pregnancy, Addictions Services are required to attend meetings and provide a written report to the Initial Child Protection Conference and the Review Child Protection Conference. Within Child Protection Core Groups the Addictions Service will endeavour to be represented and will always provide a written report to such meetings.

Post-Natal Period 6.6 Detailed discharge plan for prescribing support and monitoring of mother will be

discussed, Addictions Services plan agreed and shared at the pre-discharge meeting.

6.7 CNTW will be given detailed discharge plan for prescribing support and monitoring

specifically of baby in order to support safeguarding.

6.8 If safeguarding procedures are initiated post-natally, Addictions Services are required to attend and provide a written report to the Initial Child Protection Conference and the Review Child Protection Conference. Within Child Protection Core Groups the Addictions Service will endeavour to be represented and will always provide a written report to such meetings.

Minimum Standards

Addictions Services will always attend an Initial Child Protection Conference/Review Child Protection

conference and provide a written report If a core group/EHA/CAF meeting is not attended, there must be attendance at the subsequent meeting Addiction staff will receive Child Protection Supervision minimum 6 monthly from the SAPP team

Addiction Service will always attend a pre-discharge meeting Discharge arrangements, including prescribing will be clarified at pre-discharge meeting and this will be shared by CNTW in written format Risk assessment will be reviewed post-delivery

Minimum Standards

Frequency of review and rational will always be made clear in the care plan, with increased frequency where concern is escalated until risk has stabilised Addictions Services will always attend an Initial Child Protection Conference/Review Child Protection conference and provide a written report Addiction staff will receive Child Protection Supervision minimum 6 monthly from the SAPP team If a core group/EHA meeting is not attended, there must be attendance at the subsequent meeting

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7 CNTW roles in relation to Substance Misuse and Pregnancy 7.1 The roles in CNTW services who will be responsible for the on-going care during

pregnancy are:

Keyworker (KW)

Pregnancy Coordinator (PC)

Medical Staff

7.2 The Treatment Effectiveness and Governance Manager will also be responsible for

overseeing the pathway, ensuring quality and optimised treatment, alongside monitoring of safeguarding.

7.3 Roles and responsibilities are highlighted in the following pathway:

Routine enquiry re; pregnancy

Pregnancy test and confirmation via GP/obstetrics

Inform Pregnancy Coordinator (PC) and drug/alcohol

midwife

Update Risk assessment at onset and as appropriate throughout pregnancy

Seek consent to

refer to CAF/EHA

Consider safeguarding

Follow non-attendance guideline

Always inform PC if

unable to attend child protection or

CAF/EHA meetings

Always provide a written report for these meetings

Document in Review meeting format on electronic patient

record

KW role

Add to pregnancy data base

Highlight on electronic patient

record

PC role Medical role

Liaise with D& A Midwife

Pregnancy Review meeting

Routine enquiry at every appointment re

pregnancy progression

Urine and/or breathalyser at ever

appointment

Review of all new, pregnant patients

Pharmacological prescribing plan

and review

Mental Health Review

Standard

involvement in review at least at

12 weeks, 24 weeks and 36 weeks gestation

Attend pregnancy Review meetings alongside PC and

D&A Midwife

Provide pharmacological

advice to obstetric team

Monitor attendance at/escalate issues re:

LA Children’s Services/EHA .

EWEnsure repeMeetings

Member of any core group or team

around the family

Monitor pre-discharge meeting following delivery

Pre discharge meeting

attendance and follow up

PC to escalate any concern to Consultant and

Treatment Effectiveness Manager to

support a Case Review

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7.4 It is the responsibility of the keyworker to:

Ask routine enquiry pregnancy/safeguarding questions

Provide confirmation pregnancy testing

Inform pregnancy coordinator

Routine enquiry regarding pregnancy progression

Escalate any concerns to medical staff/pregnancy coordinator

Monitor risk, including safeguarding

Update risk assessment and refer as appropriate

Maintain electronic patient record

Maintain communication with partner agencies

Attend any child in need/ child protection /EHA meetings

Receive Child Protection Supervision minimum 6 monthly from the SAPP team

Provide written reports for such meetings

Attend pre-discharge meeting

7.5 It is the responsibility of the pregnancy coordinator to:

Add all pregnancies to the Pregnancy Register

Monitor the day-day service for all pregnant service users

If there are concerns in relation to substance misuse, to discuss this with medical staff,

If there are concerns in relation to safeguarding to discuss this with the SAPP Team

If there are concerns in relation to not meeting minimum standards, to discuss with Treatment Effectiveness and Governance Manager

Attend the pregnancy review meeting and provide updates on the progress of all pregnant cases

Document the outcome of the review meeting in the electronic patient record

Monitor keyworker attendance at all meetings in relation to mother and baby

7.6 It is the responsibility of the medical staff to:

Provide a medical assessment as appropriate, including mental and physical health

Provide a pharmacological prescribing plan and review as appropriate

Partake in standard review at least at 12 weeks, 24 weeks and 36 week gestation

Attend pregnancy review meeting

Provide pharmacological advice as appropriate to obstetric team

Support complex case review

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7.7 It is the responsibility of the Treatment Effectiveness and Governance Manager to:

Support keyworker and Pregnancy Coordinator in relation to risk management and safeguarding in conjunction with the SAPP team

Support complex case review

Respond to any concern in relation to the meeting of minimum standards with a clear action plan

Audit keyworker records using a clear audit tool to clarify Trust standards are met in relation to care, treatment and documentation

8 Service Users not in Current Treatment 8.1 Any female who has been identified as pregnant where there are concerns in

relation to substance misuse can be referred as a priority to CNTW Addiction Services by any agency.

8.2 Priority cases with confirmed pregnancy will be seen within 24hours for assessment

and, where appropriate, will receive immediate allocation to keyworker – this will be coordinated by the Pregnancy Coordinator or Treatment Effectiveness and Governance Manager in their absence.

9 Non-attendance process 9.1 If a service user misses an appointment Keyworker must attempt to contact them in

the first instance by phone immediately. 9.2 If there is a reason for the missed appointment, this should be corroborated, a

further appointment given and outcome communicated to partner agencies. 9.3 If the keyworker is unable to contact, this should be escalated immediately to the

Pregnancy Coordinator and a plan put in place to:

Continue to attempt contacts

Liaise with pharmacy to clarify attendance

Liaise with Medical staff

Communicate with Obstetric and Social Work Partners as appropriate

Undertake a complex case review

9.4 Standard day-day supervision processes should be used to manage any day-day concern and clarify a clear plan.

10 Management of Prescriptions 10.1 Service users should always have an appointment at least 24-48 hours before their

prescription is due in order to allow adequate time to put a plan in place should they fail to attend this appointment, without any risk of them not having a current prescription.

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11 Electronic Patient Record recording by Keyworker 11.1 To support consistency and quality data recording, the keyworker will record all

sessions in the narrative progress notes of the Electronic Patient Record with the following format as appropriate:

Current week of gestation

Current prescription

Dates of prescription provided

Current Pharmacy

Current Use (Drug/Alcohol)

Last urine test results

Last appointment with midwife

Last appointment with Social Worker

Any other agency feedback

Current Reduction Plan

Physical Health

Psychological Wellbeing

Social/Domestic situation

Safeguarding Concerns/supervision

Risk assessment

Summary formulation

Plan

Next appointment

Communication to Partner Agencies

11.2 Any information/events out-with standard appointments should also be recorded in the narrative progress notes, alongside updating risk assessment where applicable.

12 Pregnancy Review Meetings 12.1 The Pregnancy Coordinator will record all discussions from the Pregnancy review

Meetings in the Electronic Patient Record within the following format:

Locality

Expected date of delivery

Addiction Keyworker

Community Midwife

Other agencies involved

Addictions appointments - Frequency/location/attendance/engagement

CNTW prescribed medication – including pickup arrangements

Current Substance Misuse

Recent Screening (AUDIT, UDT, Mental Health, TOPS/Drug Screen/Breathalyser)

Risks identified – including safeguarding and monitoring plans

Plan

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13 Audit 13.1 The Treatment Effectiveness and Governance Manager will be responsible for

auditing the Electronic Patient Record of pregnant service users within 4-6 weeks of entry onto the pregnancy database using the following audit questions:

Is the pregnancy accurately documented on pregnancy database and the Electronic Patient Record?

Is there an up-to-date care plan which considers the pregnancy?

Is there an up-to-date risk assessment which considers the pregnancy?

Are key professional documented in the contacts section of the Electronic Patient Record? (Community Midwife, Social Worker, other agencies)

Has the pregnant service user been reviewed by medical staff at 12, 24, 36 weeks?

Has the prescribing regime been reviewed / changed or reductions discussed by medical staff?

Is the pregnancy reviewed & documented at each key working session using the agreed format?

Is there evidence that the addictions key worker is communicating with other members of the care team?

Is there evidence of regular GP update letters?

If there is safeguarding / monitoring in place, is there evidence that the key worker is contributing to this process appropriately

Is the key worker accessing SAPP supervision?

Do the progress notes contain a record of each Pregnancy Review Meeting session using the agreed format?

Are child protection/safeguarding meetings attended/report provided?

13.2 The audit will highlight if the question has been fully, partially or not met. 13.3 The Audit will then identify an action plan to consider any areas which are either not

met, or only partially met. 13.4 This action plan will then be monitored by clinical supervisor. 14 Safeguarding 14.1 The Treatment Effectiveness and Governance Manager, with the support of medical

staff and pregnancy coordinator, will quality check all reports for childcare meetings and also ensure that the keyworkers are actively seeking supervision through Trust processes – Safeguarding and Public Protection Team (SAPP).

Updated Dec 2018 OBSTETRIC AND SUBSTANCE MISUSE PATHWAY: AIMS AND OBJECTIVES Appendix 1

COMMON PRINCIPLES

1. Professionals delivering care will have appropriate skills and knowledge to deal with substance misuse in pregnancy.

2. There must be a Multi-Disciplinary Team (MDT) approach to the management of high risk pregnancies involving substance misuse.

3. Pregnant women with substance misuse problems must receive the same quality of care, respect and dignity as presumed by any other woman.

4. There will be a clear understanding of professional roles and responsibilities to ensure quality of care throughout the Pathway.

5. There will be a single plan of care agreed by the multi-disciplinary team.

6. The addiction service will undertake an assessment and following this will become the main prescriber throughout the pregnancy and following the birth with regard to substance misuse related treatment

7. The addictions service will communicate with other agencies which drugs they intend to prescribe and which drugs will be prescribed by other agencies for example GP/ Obstetrician.

8. The safety of the child will be paramount.

9. There will be effective communication and integrated working between the following:

Addictions service,

NHCFT’s midwifery service including the maternity ante-natal substance misuse service.

GP.

GPWSI (GP with Special Interest).

Neonatologist where involved.

10. All agencies will have an understanding of Neonatal Abstinence Syndrome (NAS) and the risks in relation to the administration and storage of Oromorph (morphine) medication.

11. A birth plan will ALWAYS be drawn up for child protection, child in need cases

ANTE NATAL PRINCIPLES:

The common principles (see above) in addition to the following:

1. There must be early identification of high risk pregnancies and referral to specialist services, as per referral pathway.

2. All pregnant women will be offered a named doctor and midwife.

3. A birth plan will always be drawn-up and this will be the responsibility of the community midwife and key social worker as per the agreed North of Tyne protocol (LSCB Safeguarding policies and procedures).

4. Prior to all admissions of the pregnant woman for titration, there must be discussion and agreement between NHCFT antenatal substance misuse service and the addictions service.

ON ADMISSION PRINCIPLES:


1. The inpatient maternity team must notify the MDT as per the birth plan including the pharmacist for the pregnant woman

POST NATAL PERIOD PRINCIPLES:


1. There must be a pre-discharge planning meeting.

2. There will be a robust safe plan for discharge. This must include: An assessment and evaluation of risks and safety measures regarding mother /

parents taking baby home with the responsibility to administer Oromorph and store safely.

The Neonatologists must always be included in the risk assessment.

The plan must clearly document the arrangements for treatment and prescribing with regard to mother’s substance misuse.

3. All services must be notified verbally by the hospital midwife of the discharge

date as soon as agreed and ensure a written is provided. 4. Following discharge, the community midwife will be the key worker and must

undertake daily visits to support and monitor mother and baby. 5. At the point of transfer of care the community midwife must provide a verbal

and written handover of care to the named health visitor for ongoing support and monitoring visits.

SC-PGN-03 Appendix 2

Protocol for supporting children of substance misusing parents engaged with Adult Drug and Alcohol Services – Dec 2018 (MROC2- MO) - Working together to support families and respond to Hidden Harm for families in Cumbria Northumberland

Assessment – Does client have children or is the client a parent-to-be?

Yes No

Detailed information collection as part of adult drug assessment (Box 1) Is there

already a Children’s Social Care Worker?

Does client live with someone else’s

children? Is their partner

pregnant?

No Yes

Review on regular basis (Box 2) and document decision making

process

Significant concern to health and emotional

wellbeing

Does an EHA exist? Contact EHA database Tel; 01670 623169

Yes

Feed into that plan

Continued communication with others including health visitor, school health advisor, midwife,

GP

Need for support

Discuss with others School age School Health, GP, Parenting Support Pre school Health Visitor, GP, Midwife Discuss with client/family the potential benefits of accessing additional support and then discuss with relevant practitioners identified by the family as potential EHA assessors. If you need further advice on identifying an appropriate EHA assessor, contact the Early Help Co-ordinator 01289 334000

EHA

Team around family

Lead professional identified – review meetings on a

regular basis (Box 3)

Discuss with Multi-disciplinary team and follow

safeguarding procedures

Adult service referrer is included as part of EHA

team

Always

Communicate serious concern immediately

Document

Agree process, follow up feedback

Children’s Social Care Assessment

No further action with Children’s Social Care

BOX 1 Information to be collected at adult drug assessment should include; Do you have children? How many? Do they live with you? If not, who do they live with? Do you have access? Ages? Names? GP? Health Visitor? School? Would you like any support or information on services or activities for yourself, your family or the children living with you?

BOX 2 At Reviews, changes in circumstances around children should always be ascertained.

if clients have moved

have a new partner

there are now children in their home

whether they are now living with someone who has children

NB: This protocol should be undertaken with all clients who are assessed and reviewed within

Adult Drug Services

BOX 3 Child Protection is the duty of all services. Even if you do not complete EHA’s, you have a responsibility to refer to the appropriate person and become engaged in the process

Internal check with other services i.e. GP/ contact point/

other services

No

Initial Children’s Social Care contact

NB: The EHA is voluntary, which means parents and children choose to be involved or not. If the family chooses not to consent to EHA, you should still offer any appropriate family/parenting support alongside other provision, or where appropriate, follow local safeguarding process

No concern No need for EHA. EHA

refused

SC-PGN-03 Appendix 2

Early help Assessment If Adult Drug and Alcohol Workers feel that an EHA would be beneficial to a family and need someone to help them to complete the EHA then they should have a discussion with the family as to what other services are supporting them as there could be someone who could offer help and support with this.. All paperwork relating to EHA, including documentation are available on www.northumberland.gov.uk

www.newcastlechildrensservices.org.uk

Useful Contacts For more information about training and support contact the Early Help Co-Ordinator on 01289 334000 or alternatively the EHA database on 01670 623169

Signs of Safety Model

The Signs of Safety is an innovative strengths-based, safety-organised approach to child protection casework. The Signs of Safety model is an approach created by practitioners, based on what they know works with difficult cases. We will be using the model across Children’s Services in Cumbria Northumberland in a range of ways which include helping the Team around the Family become ‘unstuck’ on difficult cases and in Child Protection conferences. For more information on the model please check www.signsofsafety.net/ and details of training can be found on the Cumbria Northumberland Children Safeguarding Board

EHA Support There is a range of EHA training and briefings and support Sessions. For further information please call 01289 334000 or www.northumberland.gov.uk And click on “E” for Early Help Assessment

Northumberland Thresholds Model A new framework outlining the thresholds for different levels of intervention from Children’s

Services is now available at; www.northumberland.gov.uk Then search for thresholds

Safeguarding procedures If you think that a child may be at risk please contact the Local Social work Team.

Alnwick 01665 626830 16+ Team 01670 712925 Ashington 01670 815060 Berwick 01289 334000 Blyth 01670 354316 Cramlington 01670 712925 Hexham 01434 603582 Morpeth (Children with Disabilities) 01670 620410 Please call the Emergency Duty Team if out of hours to speak to a social worker 0845 600 5252

Please call 999 if there is immediate risk.

Northumberland Service Directory: Northumberland has developed an online Service Directory for families. It can be accessed by children, young people, parents, carers and practitioners. It is a good starting point to identify services a family may need and you can search on key words such as mental health, childcare or bullying. The address is

http://www.northumberland.gov.uk/default.aspx?page=412

Young Carers Please remember that children and young people may be adversely affected by taking on responsibilities of care that are not always obvious. Young Carers who need support should be assessed using the EHA to ensure services are coordinated. Advice re support for these children and young people and their families can be requested from [email protected]

Additional Support Sure start Where additional support/ need are identified, ensure referrals are made to the local sure start Children’s Centre. (Pre birth -5ys) www.northumberland.gov.uk then look for sure start centres For further advice and support around services for older children and young people contact Early Help

01289 334000

http://www.northumberland.gov.uk/

http://www.newcastlechildrensservices.org.uk/

https://webmail.newcastle.gov.uk/exchweb/bin/redir.asp?URL=http://www.signsofsafety.net/



mailto:[email protected]


Documents

Safeguarding Children Practice Guidance Note V02 Planned