Safeguarding Concerns in Children- Guidance and Information for … · 2020. 2. 13. · Safeguarding Concerns in Children- Guidance and Information for the Healthcare Team Clinical

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Safeguarding Concerns in Children-

Guidance and Information for the

Healthcare Team Clinical Guideline

V2.1

February 2020

Safeguarding Concerns in Children- Guidance and Information for the Healthcare Team Clinical Guideline V2.1

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Summary

This guidance is for health care staff when concerned about the safety of a child (see 2.1. Action Flowchart) and includes a sample of the safeguarding proforma (Appendix 3).


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1. Aim/Purpose of this Guideline 1.1. This guideline is for Healthcare professionals to use when seeing a child in

which there are safeguarding concerns. The Paediatric team will be the principle users of the guideline.

1.2. This version supersedes any previous versions of this document.

1.3. Data Protection Act 2018 (General Data Protection Regulation – GDPR) Legislation

The Trust has a duty under the DPA18 to ensure that there is a valid legal basis to process personal and sensitive data. The legal basis for processing must be identified and documented before the processing begins. In many cases we may need consent; this must be explicit, informed and documented. We can’t rely on Opt out, it must be Opt in.

DPA18 is applicable to all staff; this includes those working as contractors and providers of services.

For more information about your obligations under the DPA18 please see the ‘information use framework policy’, or contact the Information Governance Team [email protected]

2. The Guidance Guidance includes an action flowchart and additional advice. The flowchart from the stand – alone ‘CLINICAL GUIDELINE FOR WHAT TO DO IF YOU ARE WORRIED ABOUT THE WELFARE OF A CHILD OR YOUNG PERSON AGED LESS THAN 18 YEARS OF AGE’ is also included. In addition, sample copies of the Safeguarding Pro-forma are provided in this pack (See Appendix 3). 2.1. Action Flowchart – see next page

mailto:[email protected]


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*If consent is refused, then in the first instance the Consultant should discuss this further with the parent / carer, however it may be necessary to obtain a specific court order through Children’s Social Care if consent is still refused.

FILING File pro-forma in usual patient notes under the safeguarding divider

TEAM TO DISCUSS CONCERNS Check ‘What to do’ flowchart

Call MARU (multi agency referral unit) or Duty Social Worker if out of hours Inform Consultant (when appropriate)

Remember contact arrangements

RESTOCK PAPERWORK

DOCUMENTATION Complete admitting paperwork including relevant body maps

Fully document all subsequent conversations with carers / other professionals

EXAMINATION / INVESTIGATIONS

USE CONSENT FORMS WITHIN PRO-FORMA - - For medical examination / investigation / photographs and information sharing

IF SKELETAL SURVEY +/- MRI REQUIRED PLEASE USE SEPARATE CONSENT FORM (CHA3773)

TAKE HISTORY Use the Paediatric Safeguarding

Pro-forma

Action Flowchart (sequence may vary)


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2.2. Additional Advice: The pro-forma contains detailed sections to aid history

taking and examination. It is useful to review these sections before going in to see the child. Particularly important points are emphasized below: -. 2.2.1. History

2.2.1.1. Social

o Who is present and what relationship are they to the child?

o Who has parental responsibility? o Who does the child live with / who is at home? o Parental alcohol / smoking and drug use (e.g. cannabis)

o If the child +/- mother only present can ask ‘do you feel safe

at home?’ 2.2.1.2. Symptoms / important areas to discuss

o Urinary (e.g. dysuria) o Genital (e.g. vaginal discharge, irritation, bleeding, smell) o Sexual experience / contraception o Sleep (e.g. night waking, nightmares) o Behaviour (e.g. wetting, soiling, self-harm, sexualised

behaviour)

Also – remember the ‘voice of the child’ in these and all consultations.

2.2.2. Examination

2.2.2.1. It is recommended that a chaperone is used (see Trust Chaperone Policy)

2.2.2.2. Include general physical examination, growth and development 2.2.2.3. Look for signs of neglect and document on the pro-forma – in

particular look for evidence of significant tooth decay 2.2.2.4. Assess general demeanour, the child’s emotional state and

also

o Describe emotional state / demeanour o Describe carers emotional state &

relationship with the child 2.2.2.5. Record size and appearance of any injuries. Note whether pain

on movement, swelling, or tenderness on palpation 2.2.2.6. Measure and draw all cutaneous bruises / marks / injuries on

the body charts included in the pro-forma 2.2.2.7. Examine genitalia and anus routinely unless contra-indicated

or permission refused 2.2.2.8. If there are concerns regarding acute sexual assault STOP

and call the Devon and Cornwall Sexual Assault Referral Centre (SARC) helpline on 0300 303 4626 for advice and guidance (24 hour service).


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2.2.3. Documentation / Evidence Have you checked the information on Child Protection Evidence (RCPCH) regarding odds ratio and likelihood of the injury being abuse? This can be accessed via the RCPCH Child Protection Companion

2.3. MAKE SURE THAT YOU HAVE ESCALATED THE CASE TO YOUR CONSULTANT TEAM WHERE APPROPRIATE

2.4. Summary - What To Do If You Are Worried About the Welfare of a Child or Young Person Aged Less Than 18 Years. –

See next page

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What To Do If You Are Worried About the Welfare of a Child or Young Person Aged Less Than 18 Years.

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3. Monitoring compliance and effectiveness

Element to be monitored

1) investigation checklist - have all the relevant investigations been undertaken 2) have body maps been used appropriately 3) has consent been obtained

Lead Dr. Simon Bedwani – Named Doctor for Child Protection

Tool Adherence to guidelines will be monitored as part of the ongoing audit process on a WORD or Excel template.

Frequency Annually or at point of investigation if required earlier.

Reporting arrangements

Safeguarding children team. Child health directorate audit and guidelines meeting

Acting on recommendations and Lead(s)

Dr Simon Bedwani

Change in practice and lessons to be shared

Required changes to practice will be identified and actioned within 3-6 months. A lead member of the team will be identified to take each change forward where appropriate. Lessons will be shared with all the relevant stakeholders

4. Equality and Diversity 4.1. This document complies with the Royal Cornwall Hospitals NHS Trust

service Equality and Diversity statement which can be found in the 'Equality, Inclusion & Human Rights Policy' or the Equality and Diversity website.

4.2. Equality Impact Assessment

The Initial Equality Impact Assessment Screening Form is at Appendix 2.

http://www.rcht.nhs.uk/GET/d10268876http://www.rcht.nhs.uk/RoyalCornwallHospitalsTrust/OurOrganisation/EqualityAndDiversity/HumanRightsEqualityAndInclusion.aspxhttp://www.rcht.nhs.uk/RoyalCornwallHospitalsTrust/OurOrganisation/EqualityAndDiversity/HumanRightsEqualityAndInclusion.aspx


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Appendix 1. Governance Information

Document Title Safeguarding Concerns in Children- Guidance and Information for the Healthcare Team Clinical Guideline V2.1

Date Issued/Approved: January 2020

Date Valid From: February 2020

Date Valid To: 17 January 2022

Directorate / Department responsible (author/owner):

Dr Simon Bedwani – Named Doctor for Child Protection.

Contact details: 01872252949

Brief summary of contents

Guidance for health care staff when concerned about the safety of a child, includes sample of safeguarding proforma

Suggested Keywords: Child protection Abuse Child Safeguarding

Target Audience RCHT CFT KCCG

Executive Director responsible for Policy:

Executive Director

Date revised: March 2018

This document replaces (exact title of previous version):

Safeguarding Concerns in Children Guidance and Information For the Health Care Team V2.0

Approval route (names of committees)/consultation:

Safeguarding Named Doctor and Named Nurse Child health audit and guidelines meeting Divisional board meeting Named Doctor for Child Death Community paediatrics

Care Group Manager confirming approval processes

Debra Shields

Name and Post Title of additional signatories

Not Required

Name and Signature of Care Group/Directorate Governance Lead

{Original Copy Signed}


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confirming approval by specialty and divisional management meetings Name: Caroline Amukusana

Signature of Executive Director giving approval

{Original Copy Signed}

Publication Location (refer to Policy on Policies – Approvals and Ratification):

Internet & Intranet Intranet Only

Document Library Folder/Sub Folder Paediatrics

Links to key external standards None

Related Documents:

Information based on the RCPCH Child

Protection Companion 2nd edition

Training Need Identified? No

Version Control Table

Date Version

No Summary of Changes

Changes Made by (Name and Job Title)

November 2014

V1.0 Initial Issue Dr.Chris Williams Dr.Georgina Clarke

March 2018

V2.0 Amendments and updates to original document

Dr Simon Bedwani Named Doctor for Child Protection Wendy Perkin –Named Nurse for Safeguarding Children

January 2020

V2.1

2.4. What To Do If You Are Worried About the Welfare of a Child or Young Person Aged Less Than 18 Years. Updated Minor formatting changes

Wendy Perkin, Named Nurse for Safeguarding Children Caroline Amukusana – Governance Lead

All or part of this document can be released under the Freedom of Information Act 2000

This document is to be retained for 10 years from the date of expiry.

This document is only valid on the day of printing

Controlled Document This document has been created following the Royal Cornwall Hospitals NHS Trust Policy for the Development and Management of Knowledge, Procedural and Web Documents (The Policy on Policies). It should not be altered in any

way without the express permission of the author or their Line Manager.


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Appendix 2. Initial Equality Impact Assessment Form

Name of Name of the strategy / policy /proposal / service function to be assessed


Directorate and service area: Child Health

Is this a new or existing Policy? Existing

Name of individual completing assessment:

Dr Bedwani

Telephone:

01872 252449

1. Policy Aim*

Who is the strategy / policy / proposal /

service function aimed at?

Clear guidance for staff concerned about a child.

2. Policy Objectives*

Clear guidance for staff concerned about a child.

3. Policy – intended Outcomes*

Evidenced based standardised practice.

4. *How will you measure the

outcome?

Audit

5. Who is intended to benefit from the

policy?

Children and families

6a Who did you consult with b). Please identify the groups who have been consulted about this procedure.

Workforce Patients Local groups

External organisations

Other

x

Please record specific names of groups Child health audit and guidelines meeting

What was the outcome of the consultation?

Guideline approved


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Are there concerns that the policy could have differential impact on: Equality Strands: Yes No Unsure Rationale for Assessment / Existing Evidence

Age X No areas indicated

Sex (male, female, trans-gender / gender reassignment)

X No areas indicated

Race / Ethnic communities /groups

X Pain added as an indicator for bruises on darker skin which may not be visible.

Disability - Learning disability, physical impairment, sensory impairment, mental health conditions and some long term health conditions.

X Those parents/carers with any identified additional needs will be referred for additional

support as appropriate - i.e to the Liaison team or for specialised equipment. Written information will be provided in a format to meet the family’s

needs e.g. easy read, audio etc

Religion / other beliefs


Marriage and Civil partnership


Pregnancy and maternity


Sexual Orientation, Bisexual, Gay, heterosexual, Lesbian


You will need to continue to a full Equality Impact Assessment if the following have been highlighted:

You have ticked “Yes” in any column above and

No consultation or evidence of there being consultation- this excludes any policies which have been identified as not requiring consultation. or

Major this relates to service redesign or development

8. Please indicate if a full equality analysis is recommended. Yes No

X

9. If you are not recommending a Full Impact assessment please explain why.

No areas indicated

7. The Impact Please complete the following table. If you are unsure/don’t know if there is a negative impact you need to repeat the consultation step.


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Date of completion and submission

04 February 2020 Members approving screening assessment

Policy Review Group (PRG) APPROVED

This EIA will not be uploaded to the Trust website without the approval of the Policy Review Group. A summary of the results will be published on the Trust’s web site.


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Appendix 3. Safeguarding Children Medical Pro-forma


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